Skip to main content

Advertisement

SpringerLink
Log in

Adjuvant therapy of colorectal cancer

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: This review was undertaken to examine the evidence of the effectiveness of adjuvant chemotherapy in colorectal cancer. METHODS: Published studies were reviewed and analyzed. RESULTS: For over three decades, a large series of adjuvant systemic trials have been conducted in carcinoma of the colon and rectum in an attempt to reduce recurrence and ultimately improve survival. However, only in the last few years have significant gains been made. In colon cancer with regional nodal metastasis, combined treatment with 5-fluorouracil and levamisole has resulted in significant reduction of tumor recurrence and improved survival. In rectal cancer, combined modality treatment with radiotherapy and chemotherapy is considered the standard for care by many investigators, although numerous questions remain unanswered. CONCLUSIONS: The existing evidence suggests that adjuvant therapy may be of value in selected patients with colorectal cancer. Several currently active trials are pursuing very hopeful leads, and clinicians are encouraged to enter their patients on available trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hardcastle JD, Thomas WM, Chamberlain J,et al. Randomised controlled trial of faecal occult blood screening for colorectal cancer: results for the first 107,349 subjects. Lancet 1989;1:1160–4.

    PubMed  Google Scholar 

  2. Mrazek R, Economou S, McDonald GO, Slaughter DP, Cole TO. Prophylactic and adjuvant use of nitrogen mustard in the surgical treatment of cancer. Ann Surg 1959;150:745–55.

    PubMed  Google Scholar 

  3. Buyse M, Zeleniuch-Jacquotte A, Chalmers TC. Adjuvant therapy of colorectal cancer. Why we still don't know. JAMA 1988;259:3571–8.

    PubMed  Google Scholar 

  4. Wolmark N, Fisher B, Rockette H,et al. Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01. J Natl Cancer Inst 1988;80:30–6.

    PubMed  Google Scholar 

  5. Laurie JA, Moertel CG, Fleming TR,et al. Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. J Clin Oncol 1989;7:1447–56.

    PubMed  Google Scholar 

  6. Moertel CG, Fleming TR, Macdonald JS,et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990;322:352–8.

    PubMed  Google Scholar 

  7. Moertel C, Fleming T, MacDonald J, Haller D, Laurie J. The intergroup study of fluorouracil (5-FU) plus levamisole (Lev) and levamisole alone as adjuvant therapy for stage C colon cancer. Proc Am Soc Clin Oncol 1992;11:161.

    Google Scholar 

  8. Mixed European reactions to American colorectal data. Ann Oncol 1990;1:239.

    Google Scholar 

  9. Buroker TR, Moertel CG, Fleming TR,et al. A controlled evaluation of recent approaches to biochemical modulation or enhancement of 5-fluorouracil in colorectal carcinoma. J Clin Oncol 1985;3:1624–31.

    PubMed  Google Scholar 

  10. Moertel CG. Surgical adjuvant treatment of colorectal cancer. Forum 1992;2:426–37.

    Google Scholar 

  11. O'Connell M, Mailliard J, Macdonald J, Haller D, Mayer R, Wieand H. An intergroup trial of intensive course 5FU and low dose leucovorin as surgical adjuvant therapy for high risk colon cancer. Proc Am Soc Clin Oncol 1993;12:190.

    Google Scholar 

  12. Wolmark N, Rockette H, Fisher B,et al. Leucovorinmodulated 5-FU (LV-FU) as adjuvant therapy for primary colon cancer: NSABP C-03. Proc Am Soc Clin Oncol 1993;12:197.

    Google Scholar 

  13. Zaniboni A, Erlichman C, Scitz JF,et al. FUFA increases disease-free survival (DFS) in resected B2C colon cancer (CC): results of a prospective pooled analysis of 3 randomized trials (RCTs). Proc Am Soc Clin Oncol 1993;12:191.

    Google Scholar 

  14. Taylor I, Brooman P, Rowling JT. Adjuvant liver perfusion in colorectal cancer: initial results of a clinical trial. BMJ 1977;2:1320–2.

    PubMed  Google Scholar 

  15. Taylor I, Manchin D, Mullee M, Trotter G, Cooke T, West C. A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer. Br J Surg 1985;72:359–63.

    PubMed  Google Scholar 

  16. Ryan J, Weiden P, Crowley J, Bloch K. Adjuvant portal vein infusion for colorectal cancer: a 3-arm randomized trial. Proc Am Soc Clin Oncol 1988;7:95.

    Google Scholar 

  17. Gray BN, deZwart J, Fisher R. The Australia and New Zealand trial of adjuvant chemotherapy in colon cancer. In: Salmon SE, ed. Adjuvant therapy of cancer V. Philadelphia: Grune & Stratton, 1987:537–46.

    Google Scholar 

  18. Beart RW Jr, Moertel CG, Wieand HS,et al. Adjuvant therapy for resectable colorectal carcinoma with fluorouracil administered by portal vein infusion. Arch Surg 1990;125:897–901.

    PubMed  Google Scholar 

  19. Wolmark N, Rockette H, Wickerham DL,et al. Adjuvant therapy of Duke's A, B, and C adenocarcinoma of the colon with portal-vein fluorouracil hepatic infusion: preliminary results of National Surgical Adjuvant Breast and Bowel Project Protocol C-02. J Clin Oncol 1990;8:1466–75.

    PubMed  Google Scholar 

  20. Laffer U, Metzger U, Pampallona S, Castiglione M. Adjuvant intraportal chemotherapy for colorectal cancer. 8-year results of the randomized Swiss trial (SAKK 40/81). Proc Am Soc Clin Oncol 1993;12:220.

    Google Scholar 

  21. Wereldsma JC, Bruggink ED, Meijer WS, Roukema JA, van Putten WL. Adjuvant portal liver infusion in colorectal cancer with 5-fluorouracil/heparin versus urokinase versus control. Results of prospective randomized clinical trial (colorectal adenocarcinoma trial I). Cancer 1990;65:425–32.

    PubMed  Google Scholar 

  22. Fielding LP, Hittinger R, Grace RH, Fry JS. Randomised controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectal adenocarcinoma. Lancet 1992;340:502–6.

    PubMed  Google Scholar 

  23. Gérard A, Buyse M, Nordlinger B,et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer: final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 1988;208:606–14.

    PubMed  Google Scholar 

  24. Higgins GA, Humphrey EW, Dwight RW, Oswit B, Lee LE Jr, Keehn J. Preoperative radiation and surgery for cancer of the rectum: Veterans Administration Surgical Oncology Group Trial II. Cancer 1986;58:352–9.

    PubMed  Google Scholar 

  25. Gastrointestinal Tumor Study Group. Prolongation of the disease-free survival in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72.

    Google Scholar 

  26. Bentzen SM, Baslev I, Pedersen M,et al. A regression analysis of prognostic factors after resection of Duke's B and C carcinoma of the rectum and rectosigmoid: does post-operative radiotherapy change the prognosis? Br J Cancer 1988;58:195–201.

    PubMed  Google Scholar 

  27. Fisher B, Wolmark N, Rockette H,et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP Protocol R-01. J Natl Cancer Inst 1988;80:21–9.

    PubMed  Google Scholar 

  28. Douglass HO Jr, Moertel CG, Mayer RJ,et al. Survival after postoperative combination treatment of rectal cancer. N Engl J Med 1986;315:1294–5.

    PubMed  Google Scholar 

  29. Krook J, Moertel CG, Gunderson LL,et al. Surgical adjuvant therapy for high risk rectal carcinoma. N Engl J Med 1991;324:709–15.

    PubMed  Google Scholar 

  30. O'Connell M, Wieand HS, Krook J,et al. Lack of value for methyl-CCNU as a component of rectal cancer surgical adjuvant therapy: interim analysis of Intergroup Protocol 86-47-51. Proc Am Soc Clin Oncol 1991;10:134.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology II, Regina Elena Institute for Cancer Research, Rome, Italy

    Massimo Lopez M.D.

Authors
  1. Massimo Lopez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Lopez, M. Adjuvant therapy of colorectal cancer. Dis Colon Rectum 37 (Suppl 2), S86–S91 (1994). https://doi.org/10.1007/BF02048438

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02048438

Key words

Search

Navigation