Skip to content

Colorectal Cancer Health Center

Font Size

Treatment Option Overview

    continued...

    Chemotherapy

    Subsequent studies have attempted to increase the survival benefit by improving radiation sensitization and by identifying the optimal chemotherapeutic agents and delivery systems. The agents associated with the first successful combined-modality treatments were 5-FU and semustine. Semustine is not commercially available, and previous studies have associated this drug with the potential for increased risks of renal toxic effects and leukemia.

    A follow-up randomized trial from GITSG demonstrated that semustine does not produce an additive survival benefit to radiation therapy and 5-FU.[14][Level of evidence: 1iiA] The Intergroup 86-47-51 trial (NCCTG-864751 [MAYO-864751]) showed a 10% improvement in OS with the use of continuous-infusion 5-FU (225 mg/m2 /day) throughout the course of radiation therapy when compared with bolus 5-FU (500 mg/m2 times three injections in the first and fifth weeks of radiation).[15][Level of evidence: 1iiA]

    Subsequently, several studies attempted to determine the optimal way to deliver adjuvant 5-FU. The final results of Intergroup 0114 (INT-0114 [CLB-9081]) demonstrated no survival or local control benefit with the addition of leucovorin (LV), levamisole, or both to 5-FU administered postoperatively for stage II and III rectal cancers at a median follow-up of 7.4 years.[16][Level of evidence: 1iiA] Another study, Intergroup 0144 (SWOG-9304 [NCT00002551]), was a three-arm randomized trial designed to determine whether continuous-infusion 5-FU throughout the entire standard six-cycle course of adjuvant chemotherapy was more effective than continuous 5-FU only during pelvic radiation.[17]

    • Arm 1 received bolus 5-FU in two 5-day cycles before (500 mg/m2 /day) and after (450 mg/m2 /day) radiation therapy, with protracted venous infusion 5-FU (225 mg/m2 /day) during radiation therapy.
    • Arm 2 received continuous infusion 5-FU before (300 mg/m2 /day for 42 days), after (300 mg/m2 / day for 56 days), and during (225 mg/m2 /day) radiation therapy.
    • Arm 3 received bolus 5-FU plus LV (5-FU/LV) in two 5-day cycles before (5-FU 425 mg/m2 /day; LV 20 mg/m2 /day) and after (5-FU 380 mg/m2 /day; LV 20 mg/m2 /day) radiation therapy, and bolus 5-FU/LV (5-FU 400 mg/m2 /day; leucovorin 20 mg/m2 /day; days 1 to 4, every 28 days) during radiation therapy. Levamisole (150 mg/day) was administered in 3-day cycles every 14 days before and after radiation therapy.
    1|2|3|4|5|6|7|8|9

    Today on WebMD

    Colorectal cancer cells
    The right diagnosis is the most important factor.
    man with a doctor
    Our health check will steer you in the right direction.
     
    sauteed cherry tomatoes
    Fight cancer one plate at a time.
    bladder cancer x-ray
    Do you know the warning signs?
     
    bread
    ARTICLE
    Colon vs Rectal Cancer
    VIDEO
     
    New Colorectal Treatments
    VIDEO
    can lack of sleep affect your immune system
    FEATURE
     
    Cancer Facts Quiz
    QUIZ
    Virtual Colonoscopy
    VIDEO
     
    Picture of the Colon
    ANATOMY
    Vitamin D
    SLIDESHOW
     

    WebMD Special Sections