Adjuvant Radiochemotherapy

Chemo Secrets From a Breast Cancer Survivor

Breast Cancer Survivors

Get Instant Access

The efficacy of post-operative radiation and 5-fluo-rouracil (5-FU)-based chemotherapy for stage II and III rectal cancer was established by a series of prospective, randomised clinical trials (GITSG, NCCTG, NSABP) (Table 2) [22-25]. These studies demonstrated an increase in both disease-free interval and overall survival when radiation therapy is combined with chemotherapy following surgical resection. Following the publication of these trials, the National Cancer Institute (NCI) concluded at a Consensus Development Conference in 1990 that post-operative combined modality treatment is recommended for patients with stage II and III rectal carcinoma [26].

Subsequent studies have attempted to increase the survival benefit by improving radiation sensitisation, and by identifying the optimal chemotherapeutic agents and delivery systems. The chemotherapy associated with the first successful combined modality

Table 2. Surgery vs. RCT

Trial

Local failure

5-year survival

GITSG 1986 [22]

Surgery alone

24

44

Surgery+CRT

40 Gy/4 week+5-FU

11

59

NCCTG 1991 [23]

Surgery+RT

25

48

Surgery+RCT

50.4 Gy/5.5 week+5-FU/semustine

14

57

Tveit et al. [24]

Surgery alone

30

50

Surgery+RCT

46 Gy/4 week+bolus 5-FU

12

64

NSABP 2000 [25]

Surgery+CT

13

65

Surgery+RCT

50.4 Gy/5.5 week + 5-FU/folinic acid

8

66

treatments was 5-FU and semustine. The latter is not commercially available and previous studies have linked this drug to increased risks of renal toxic effects and leukaemia [27].

In 1994, O'Connell published the results of a trial showing a 10% improved overall survival with the use of a continuous infusion of 5-FU (225 mg\m2\day) throughout the course of radiation therapy when compared with bolus 5-FU (3x500 mg\m2 injections in the first and fifth weeks of radiation) [28]. Authors show no survival or local control benefit with the addition of leucovorin, levamisole or both, to 5-FU administered post-operatively for stage II and III rectal cancers at a median follow-up of 7 years [29].

New effective drugs including capecitabine, raltitrexed, irinotecan and oxaliplatin have been recently investigated in combination with radiation therapy. In addition, novel targeted biological agents including epidermal growth factor receptor inhibitors and vascular endothelial growth factor inhibitors have been shown to enhance the antitumour effect of both radiation and chemotherapy and are currently being explored in initial clinical trials [30].

Was this article helpful?

0 0
Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

Get My Free Ebook


Post a comment