Adjuvant therapy of colorectal cancer Journal Article
| Authors: | Kemeny, N.; Saltz, L.; Cohen, A. |
| Article Title: | Adjuvant therapy of colorectal cancer |
| Abstract: | In early adjuvant chemotherapy trials in the treatment of colorectal cancer, inadequate doses of chemotherapy were employed either low doses, short intervals, or inadequate oral doses. In more recent studies with longer courses of therapy with adequate doses, there is compelling evidence that adjuvant chemotherapy improves survival in patients with locally advanced colon and rectal carcinoma. Levamisole and FU given in the adjuvant setting has been shown to increase survival in patients with Dukes' C colon cancer. These studies do not demonstrate an increase in survival in Dukes' B colon cancer. Levamisole does not improve response rate or survival in patients with advanced disease, and these studies did not compare levamisole and FU to FU alone. Therefore, there is still a question of whether levamisole is needed to produce an increase in survival. Newer studies indicate that FU + LV is at least as effective as FU plus levamisole in increasing survival, and has the benefit that it may be used for shorter periods (Table 7). In future studies we may be able to better define high-risk patients with molecular markers and thereby stratify patients more effectively to understand the value of our new treatments. Further studies and further analysis of ongoing studies will help give more definitive answers to the following questions: Colon Cancer 1. Is FU + LV truly more effective than FU + levamisole? 2. Is continuous infusion useful in the adjuvant setting? 3. Are new agents such as UFT, CPT-11, Tomudex, or oxaliplatin useful in the adjuvant setting? 5. Is perioperative chemotherapy useful? 6. Are the additions of intraportal or IP therapy to systemic therapy useful? Although the addition of chemotherapy or radiotherapy alone did not increase survival in rectal cancer patients; the combination of the two modalities increased survival and decreased recurrence. The following questions already have been answered. Rectal Cancer 1. Is MeCCNU necessary? No. 2. Is continuous infusion FU useful? Yes. The following questions need to be answered. 1. Is preoperative chemotherapy plus radiotherapy more useful than postoperative therapy? 2. Is the addition of LV or levamisole to FU useful in the treatment of rectal cancer? 3. Are new agents, such as UFT, CPT-11, Tomudex, or oxaliplatin, useful with concurrent radiation therapy?. |
| Keywords: | cancer chemotherapy; cancer survival; survival rate; review; cancer recurrence; fluorouracil; antineoplastic agents; cancer adjuvant therapy; cancer radiotherapy; chemotherapy, adjuvant; radiotherapy, adjuvant; cancer staging; lymph node metastasis; lymph nodes; lymphatic metastasis; colorectal cancer; cancer immunotherapy; neoplasm recurrence, local; antimetabolites, antineoplastic; colonic neoplasms; thiotepa; liver metastasis; folinic acid; drug infusion; forecasting; preoperative treatment; adjuvants, immunologic; floxuridine; rectal neoplasms; infusions, intravenous; leucovorin; portal vein; clinical trials; oral drug administration; levamisole; uft; intraperitoneal drug administration; antidotes; humans; prognosis; human |
| Journal Title: | Surgical Oncology Clinics of North America |
| Volume: | 6 |
| Issue: | 4 |
| ISSN: | 1055-3207 |
| Publisher: | Elsevier Inc. |
| Date Published: | 1997-10-01 |
| Start Page: | 699 |
| End Page: | 722 |
| Language: | English |
| PUBMED: | 9309089 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Export Date: 17 March 2017 -- Source: Scopus |
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