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Interactive Case Discussions: Beyond High-Risk Features - Can ctDNA Redefine Adjuvant Decision-Making in Stage II Colon Cancer?
Dr. Jenson Sow presents a Stage II colon cancer case illustrating how postoperative ctDNA-based minimal residual disease (MRD) testing can refine recurrence risk assessment and support more individualized adjuvant treatment decisions beyond conventional pathological risk factors.
Using a Stage II sigmoid colon cancer case, Dr. Jenson Sow explores one of the most challenging questions in colorectal oncology: which patients truly benefit from adjuvant chemotherapy after curative surgery. The session reviews the evolution of postoperative risk stratification—from TNM staging and high-risk pathological features to molecular biomarkers such as mismatch repair status and circulating tumor DNA (ctDNA).
Clinical evidence from landmark studies including DYNAMIC and CIRCULATE is presented to demonstrate how postoperative ctDNA has emerged as the strongest validated prognostic biomarker for detecting minimal residual disease following surgery. By identifying molecular relapse months before radiological recurrence, DYNAMIC demonstrated that ctDNA enables clinicians to better distinguish patients who may safely avoid chemotherapy from those at significantly higher risk of recurrence.
Returning to the featured case, postoperative ctDNA positivity prompts reconsideration of conventional management despite otherwise favourable pathological features. The presentation highlights both the promise and current limitations of ctDNA-guided treatment, emphasizing that while molecular residual disease testing is transforming postoperative risk assessment, ongoing prospective trials will continue defining its role in treatment escalation and precision adjuvant therapy.
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