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Query: UMLS:C0699790 (colon cancer)
 28,837 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical studies on adjuvant chemotherapy in colorectal cancer started 30 years ago, but some proof of its effectiveness did not come until recently. Only randomized prospective studies can provide definite evidence in this regard. Obviously, the potential value of an effective adjuvant treatment for a frequent disease such as colorectal cancer is enormous. Randomized studies had failed to provide evidence in favour of adjuvant chemotherapy in colon cancer until a recently reported study on 5-fluorouracil and levamisole. As of today, the latter regimen may be considered as the reference one for adjuvant chemotherapy in Dukes C colon cancer. In rectal cancer some studies displayed statistically significant results in favour of adjuvant chemotherapy: however, sufficient data are still unavailable to support adjuvant chemotherapy as standard treatment. On the contrary, postoperative radiotherapy is definitely effective in decreasing local relapses. Studies are underway on the combination of chemotherapy and radiotherapy in rectal cancer. In addition to systemic chemotherapy, portal infusion of cytotoxic drugs has been tested in colorectal cancer. Controlled studies are underway, but available results would not seem to support regional treatment. Recent improvement in the chemotherapy of advanced colorectal cancer has probably occurred through the pharmacologic modulation of 5-fluorouracil by leucovorin. If this will be confirmed, one will be able to resort to more effective multidrug regimens than those tested so far and an improvement in adjuvant chemotherapy may be anticipated too.
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PMID:[Adjuvant chemotherapy of colorectal carcinoma]. 210 Sep 69

Surgery is the primary mode of therapy for colonic and rectal cancer. The principles of surgery are: laparotomy for staging, wide en bloc resection of the primary tumor and lymphadenectomy for staging as well as possible therapeutic benefit. Reasonable efforts should be made intraoperatively to prevent intraluminal and intraperitoneal spread. Resection of metastases can prolong survival in stage D patients confined to the liver. Dukes C colon cancer patients should receive multiagent chemotherapy. There is no well defined role for radiation therapy as adjuvant treatment in colon cancer. Local failure pattern and treatment strategies are different for cancer of the rectum. Surgery remains the mainstay of treatment for all lesions; other modalities are adjunctive. Lesions within 5 cm of the anal verge usually require abdominoperineal resection, while the other are treated with a low anterior resection. New techniques are emerging to preserve the anal sphincter and gastrointestinal continuity, and these are being tested to determine if adequate tumor control is obtained.
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PMID:[Surgery of colorectal carcinoma]. 750 17

Micrometastatic spread of viable carcinoma cells is thought to be the leading cause of death in patients with completely resectable colorectal cancer. Since this minimal spread is missed by current tumor staging procedures, immunocytochemistry with monoclonal antibodies to epithelial cytokeratins have been successfully applied to detect individual carcinoma cells disseminated to mesenchymal organs such as bone marrow. Although the skeleton is not a preferential site of overt metastases in colon cancer, individual cytokeratin-positive tumor cells in bone marrow can be detected in about 30% of patients with no clinical signs of overt metastases (stage MO). The presence of these cells in bone marrow at the time of primary surgery turned out to be a strong independent indicator for subsequent relapse in organs such as liver and lungs. In a randomized, multicenter trial it could be furthermore demonstrated that the intravenous administration of the monoclonal antibody 17-1A into patients with Dukes C colon cancer significantly reduced the overall death rate by 30% and decreased the recurrence rate by 27%, thus underscoring the accessibility of micrometastatic tumor cells for immunotherapy. The present article reviews the current state of immunologic strategies used to detect, characterize, and treat minimal residual colon cancer.
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PMID:Immunodiagnosis and immunotherapy of isolated tumor cells disseminated to bone marrow of patients with colorectal cancer. 757 Oct 61

Colorectal adenocarcinoma is diagnosed in 150,000 Americans yearly, and more than 50,000 die of this disease each year. Recently, as a result of well-controlled, randomized, cooperative group trials, it has been demonstrated that adjuvant therapy of node-positive colon cancer (stage III) and node-positive or negative rectal cancer (stage II or stage III) can reduce recurrence and mortality and significantly improve overall survival. It is now the standard of care to provide adjuvant chemotherapy with 5-fluorouracil and levamisole for patients with node-positive colon cancer and provide adjuvant chemoradiotherapy with both 5-fluorouracil and high-dose radiotherapy for patients with stage II or stage III rectal cancer. It is estimated that these interventions, which are readily tolerated, will reduce the incidence of recurrence by more than 30% in both patient groups at a reasonable economic and health cost. Although the ideal method of therapy for this type of disease is not yet firmly established, it appears that adjuvant therapy for node-negative stage III colon cancer may be effective as well. Recently completed and ongoing cooperative group trials are investigating different combinations of chemotherapy and radiotherapy, including 5-fluorouracil with the biomodulator leucovorin or continuous-infusion 5-fluorouracil with radiotherapy, and comparing different durations of therapy. Other trials are investigating combined modality therapy for the neoadjuvant treatment of locally advanced rectal cancer. New findings in the genetics of colon cancer are being studied as prognostic information or markers to determine whether there are subsets of patients who might benefit from more or less therapy. Randomized placebo-controlled trials have been initiated to study the use of aspirin as a means of colon cancer prevention in high-risk populations. Taken together, the recent advances in our treatment and understanding of colorectal adenocarcinoma have resulted in a major--albeit silent--revolution in therapy and give firm promise for further progress.
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PMID:Adjuvant treatment of colorectal adenocarcinoma. 826 16

Patients who underwent potential curative surgery for colonic adenocarcinoma were enrolled in a prospectively randomised, controlled clinical trial of combined intraperitoneal (i.p.) plus systemic intravenous (i.v.) chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV). We investigated whether this adjuvant treatment approach, specifically addressing the risk of peritoneal and hepatic recurrence, could improve disease-free and overall survival. Between May 1988 and December 1990, 121 patients with resected stage III or high-risk stage II (T4N0M0) colon cancer were randomly assigned for observation (which was considered standard care until the NIH consensus conference) or adjuvant chemotherapy with LV (200 mg/m2) plus 5-FU (350 mg/m2), both given i.v. (days 1-4) and i.p. (days 1 and 3) every 4 weeks for a total of six courses. After a median follow-up time of 4.6 years, a comparative analysis between the two groups of patients suggested both an improvement in disease-free survival (75% versus 58%; P = 0.06) and a survival advantage (78% versus 63%; P = 0.05) in favour of adjuvant chemotherapy. The sites of recurrence were also different, i.e. local regional and intrahepatic tumour recurrences were observed in only 6/58 (10%) and 5/58 (9%) adjuvant treated patients as compared to 11/60 (18%) and 10/60 (17%) observed patients. The overall benefit of adjuvant therapy appeared to be greatest in patients with stage III colon cancer. Treatment-associated toxicity was infrequent and generally mild with only 5% experiencing severe (WHO grade 3) adverse reactions. Interim results of this adjuvant trial suggest that combined i.p. plus systemic i.v. chemotherapy with 5-FU and LV represents a potentially effective adjuvant regimen in stage II/III colon cancer.
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PMID:Combined intraperitoneal plus intravenous chemotherapy after curative resection for colonic adenocarcinoma. 856 52

There have been no life-prolonging effects of surgical adjuvant chemotherapy with 5-FU alone or in combination with chemotherapeutic drugs, so surgical resection has been considered a standard therapy for colorectal cancer. Recently, clinical trials of modulation therapy with 5-FU and leucovorin showed higher efficacies in advanced colorectal cancer, and significant prolongations of survival time and disease-free interval were reported in a randomized trial of 5-FU and leucovorin for postoperative adjuvant therapy of resected colon cancer. Moreover, in a scientifically well controlled randomized study with 5-FU and levamisole, the significance of this regimen for Dukes C colon cancer has been shown for standard adjuvant chemotherapy.
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PMID:[Progress of adjuvant chemotherapy in colon cancer]. 867 12

The relatively high response rate demonstrated with the use of continuous infusion 5-Fluorouracil (CIFU) 200 to 300 mg/m2 per day in disseminated colon cancer is the rationale behind a NCI-sponsored intergroup trial (INT 0153) for postoperative adjuvant therapy of stage III colon cancer. Because CIFU necessitates a significant reduction in the dose of the modulator leucovorin compared with bolus 5-FU, a pilot study of continuous infusion 5-FU in several doses with levamisole was conducted to determine any unexpected toxicity of this combination, and to assess completion rates of levamisole was conducted to determine any unexpected toxicity of this combination, and to assess completion rates of this dose intensive schedule. CIFU, scheduled as two 12-week cycles, was administered at 250 mg/m2 per day. Pending toxicity at the initial dose, CIFU was to be escalated (300 mg/m2) or de-escalated (200 mg/m2). All but one patient entered on this trial completed 24 weeks of adjuvant CIFU+levamisole. Eight patients (57%) completed 24 weeks of therapy with the 2-week scheduled break. One of these 8 patients required a dose reduction without interrupting the schedule. Six patients had toxicity from the CIFU, which obliged us to interrupt the schedule. Limiting toxicities were stomatitis and hand-foot syndrome. No dose-limiting hematologic toxicity was encountered. Three patients (21%) had catheter problems that required replacement. These data suggest that up to 30% of patients started on this regimen may require dose reduction, shorter infusion courses with rest breaks, or both to complete 24 weeks of adjuvant treatment in order to achieve desired dose intensity.
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PMID:A pilot trial of continuous infusion 5-fluorouracil with levamisole for adjuvant therapy of colon cancer. 880 55

In the mid-1980s, trials of adjuvant therapy for colon cancer in the United States had a "no treatment" arm, which reflected the belief that effective adjuvant chemotherapy did not exist for patients with surgically resected disease at high risk for recurrence. However, with the observation in the early 1990s that postsurgical adjuvant 5-FU plus levamisole reduced tumor recurrence and ultimately increased overall survival in stage III colon cancer, the potential of effective adjuvant chemotherapy was realized. Questions about the duration of adjuvant chemotherapy, the specifics of chemotherapy schedule/drug selection, and its use in stage II colon cancer are beginning to be clarified in large, randomized adjuvant therapy trials. In rectal carcinomas, combined modality postoperative pelvic irradiation plus chemotherapy for stage II and III disease has been shown to reduce both local and systemic recurrences and to prolong survival compared with that in patients treated with local surgery and radiation. Again, large randomized trials are attempting to clarify both the optimal chemotherapeutic agents and schedules to be used and also whether preoperative combined modality therapy can improve the resectability rate, rate of sphincter preservation, and survival. Future trials will examine new agents shown to be effective in advanced disease as well as monoclonal antibodies, such as MoAb 17-1A, that may have selective activity in minimal disease. Improvement in overall survival remains the ultimate endpoint of future adjuvant therapy trials; however, trials will also critically examine toxicity, quality of life, pharmacoeconomics, and genetic and biologic correlates that may help select more appropriate candidates for adjuvant therapies.
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PMID:Adjuvant medical therapy for colorectal cancer. 909 11

Adjuvant therapy for colon cancer is now a mature and widely accepted standard of care for patients with resected large bowel tumors: adjuvant therapy for stage III colon cancer has also been shown to be highly cost-effective. The cost of 5-FU/levamisole therapy for stage III colon cancer per year of life saved is less than $ 5,000, which represents a favorable cost-benefit relationship for a medical intervention. The clinician managing a patient with colon cancer at the present time has several options for therapy. In patients with stage III colon cancer, therapy with 5-FU-based regimens clearly increases overall and disease-free survival. It is also clear that the results that have been obtained are not perfect; therefore, the first option of therapy should always be an ongoing clinical trial. Many such trials are available, and Table 7 lists currently active studies in the United States. The clinician managing a patient with stage III colon cancer who is not in a clinical trial may choose a variety of regimens administered for durations of 6 to 12 months (Table 8). The preponderance of evidence suggests that 5-FU plus levamisole for 12 months is equal in efficacy to 5-FU plus leucovorin-based regimens given for a shorter period of time. A clinician may still choose the 5-FU plus levamisole regimen because of the decreased oral, myelosuppressive, and diarrheal toxicities associated with that regimen as opposed to the 5-FU/leucovorin regimens. Portal vein infusion of fluorinated pyrimidines still must be considered investigational. Finally, although we cannot be absolutely sure about the benefit of adjuvant therapy in patients with resected node-negative colon cancer, the NSABP data suggest that some benefit may be seen in these patients. It is known that patients with stage II cancers demonstrating high-grade bowel obstruction or bowel perforation have poor prognoses with surgery alone. Such patients may be good candidates for adjuvant therapy. Also, a major effort to define high risk and low risk for recurrence in patients with stage II colon cancer by analyzing molecular genetic factors (tumor ploidy and alternations in tumor suppressor genes) may lead to a selection of Dukes B patients definitely requiring adjuvant therapy.
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PMID:Adjuvant therapy for colon cancer. 924 73

To evaluate the significance of postoperative adjuvant chemotherapy, randomized controlled trials of adjuvant chemotherapy after curative resection for colorectal cancer were reviewed. Several multiple-drug systemic chemotherapy (MOF, MMC/FT p.o., MMC/5-FU p.o., MMC/ UFT po) were useful as adjuvant treatment to improve survival or disease-free survival for patients with colorectal cancer. And worldwide meta-analysis found that continuous intraportal 5-FU was suggested to improve survival. Recently, combination chemotherapy trials utilizing 5-FU and levamisole, or 5-FU and leucovorin, demonstrated significant a survival advantage in the patients with high risk colon cancer, and these are widely used as adjuvant treatment for patients with Dukes C resected colon cancer. From results of many Japanese trials, although the effectiveness of adjuvant treatment for colorectal cancer still remain controversial, postoperative adjuvant chemotherapy is thought to improve the disease-free survival of patients after resection of rectal cancer or Dukes C colon cancer.
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PMID:[The current status of postoperative adjuvant chemotherapy for colorectal cancer]. 927 41


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