Each year, about one million people worldwide are diagnosed with colorectal cancer and about half that number dies from the disease. After colon tumors are removed surgically, many patients are treated with fluorouracil-based adjuvant chemotherapy. Whether the chemotherapy should be delivered via the systemic or regional methods, however, has been controversial.
To test the effectiveness of both methods of chemotherapy, Roberto Labianca, M.D., of the Ospedali Riuniti in Bergamo, Italy, and colleagues conducted a randomized clinical trial of 1084 patients with colon carcinoma in Dukes' stage B or C who were recruited between 1992 and 1998. After surgery, the patients received the regional regimen, the systemic regimen, or regional followed by systemic chemotherapy.
Survival rates after 5 years--74% for the regional regimen, 78% for the systemic regimen, and 73% for the combination--were similar for all three groups, as were rates of survival without recurrences or second malignancies. However, only 9% of patients who received the regional regimen experienced an adverse reaction to the chemotherapy compared with 47% who received the systemic regimen.
"The main result of this study is that the combination [systemic plus regional] regimen did not provide an additive benefit and, in fact, was similar to that of the chemotherapy delivered by either the [regional] regimen or the [systemic] regimen alone. Overall survival and event-free survival rates were similar among all three groups," the authors write.
In an editorial, Jean L. Grem, M.D., of the University of Nebraska Medical Center in Omaha, discusses the difficulty in studying the various regimens of adjuvant chemotherapy available for treating colorectal cancer. She concludes that, "The clinical research strategy for the adjuvant therapy of colon cancer must be focused, yet flexible, to accommodate the evolving status of available novel therapies."
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