Adjuvant chemotherapy with 5-fluorouracil after surgical resection of colorectal carcinoma (COG protocol 7041)

Grage, Theodor B.; Metter, Gerald E.; Cornell, George N.; Strawitz, Joseph G.; Hill, George J.; Frelick, Robert W.; Moss, Scot E.

doi:10.1016/0002-9610(77)90194-5

Cited by 44 publications

(10 citation statements)

References 14 publications

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“…In each case, autopsy or re-exploration confirmed this failure pattern, The incidence of distant metastasis (DM) in liver, lung, or other hematologic sites (bone or brain) is 16.2% (23/ 142). The incidence of distant metastasis associated with local failure (LR/DM) is 13.3% (19/142), and the overall incidence of distant failure is 29.5% (42/142, DM plus LR/DM) ( Table 5).…”

Section: Peritoneal Seeding Distant Metastasismentioning

confidence: 99%

Patterns of recurrence of rectal cancer after potentially curative surgery

Rich

Gunderson

Lew

et al. 1983

Cancer

497

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The results of surgical treatment alone for 142 cases of carcinoma of the rectum and rectosigmoid from the Massachusetts General Hospital were reviewed. The incidence of local failure as any component of failure was found to be strongly dependent on the pathologic stage, and for Dukes' A was 8.0% (3/39); Dukes' B, 31% (18/59), and Dukes' C, 50% (22/44). The incidence of local failure for tumors without lymph node metastasis was 17% with only microscopic extension through the wall (modified Astler‐Coller Stage MAC‐B2m), but increased to 54% in tumors that were adherent to or invading adjacent organs and structures (MAC‐B3). Similarly, in tumors with positive lymph nodes, there was a 36% incidence of local failure for tumors confined to the wall or with only microscopic extension through the wall (MAC‐C1/C2m), compared to a 67% incidence for tumors with adherence or involvement of adjacent organs (MAC‐C3). Other predictors of local recurrence were the tumor location, grade, number of lymph nodes, and blood vessel invasion. The pathologic factors predicting distant metastasis are also presented. Five‐year survival for Dukes' A was 77% (30/39); Dukes' B, 44% (26/59); and Dukes' C, 23% (10/44). The implications for future adjuvant therapy based on the identification of patients with the highest risk for local and distant failure are discussed.

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Section: Peritoneal Seeding Distant Metastasismentioning

confidence: 99%

Patterns of recurrence of rectal cancer after potentially curative surgery

Rich

Gunderson

Lew

et al. 1983

Cancer

497

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“…Various other reports suggest that patients who did have leukopenia were more likely to benefit from the chemotherapy. In a study of adjuvant chemotherapy with fluorouracil after surgical resection of colorectal carcinoma, Grage et al [9] showed that patients who had leukocyte counts less than 4000 per mm3 had significantly prolonged disease-free interval than patients without hematological toxicity. In 171 patients who received melphalan or CMF as adjuvant therapy for breast cancer, Carpenter et a1 [lo] found a significantly decreased relapse only for patients who received melphalan and also experienced a leukocyte count of less than 3000 per mm3 during treatment.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy (CMF) for breast carcinoma: Hematological side effects

Lee

1982

Journal of Surgical Oncology

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Seventy-five patients accepted postmastectomy adjuvant CMF chemotherapy for stage II and III carcinoma of the breast. All patients, irrespective of age, were started on the same drug dosages. About 42% of the patients had leukopenia during the first two cycles; this rate was similar for patients who dropped out of the program early and those who stayed on for six or more months. Patients who developed leukopenia early are more likely to receive less than 65% of mean total CMF dosages (MTD). Otherwise, 30% of patients that never had leukopenia or had leukopenia that appeared late received more than 85% of the prescribed CMF. In our series, postmenopausal patients did not have more problem with leukopenia than premenopausal patients (thrombocytopenia occurred rarely in both groups). Among the 58 patients who had CMF for 6 months or longer, 79% had less than 85% MTD or CMF. The dosages had to be reduced for drug-related and other reasons, and leukopenia only accounted for 22% of patients who had reduced CMF dosages.

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“…In the Central Oncology Study the doses of 5-FU were more appropriate, and in patients with rectal carcinoma, the treated group of patients had a significant increase in survival with a median survival of 60 months vs 20 months for patients in the control group (P = .005) [217]. Rousselot [18], in a nonrandomized study, administered 5-FU directly into the isolated large bowel lumen at the time of surgery, followed by additional doses of 5-FU intravenously, and reported a 58% 8-year survival in patients with Dukes' C lesions.…”

Section: Peritoneal Chemotherapymentioning

confidence: 99%

Role of chemotherapy in the treatment of colorectal carcinoma

Kemeny

1987

Seminars in Surgical Oncology

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Large bowel cancer afflicts more patients in the United States than any other malignancy excluding skin cancer. Fifty percent of patients who undergo resection of colorectal carcinoma have positive lymph nodes, and approximately 18% have liver metastases at initial presentation. To improve survival, more effective treatment than surgical resection of the primary must be developed. The most active single agent in the treatment of colorectal carcinoma is 5-fluorouracil (5-FU). To increase the response rate obtained with this agent, work has been done on the modulation of 5-FU by other agents, using drugs that are synergistic with 5-FU and manipulating the method of 5-FU administration. Combination chemotherapy has improved response rates in some situations, though generally it has not been shown to improve survival. Studies using direct hepatic infusion clearly demonstrate an increase in response rates, but again, it is too early to say whether this type of treatment increases survival. Early adjuvant chemotherapy trials used inadequate doses of chemotherapy for short periods of time and demonstrated no added efficacy to surgery alone. Later studies with more aggressive therapy suggested some benefit to treating patients with rectal carcinoma; however, there is still little evidence that adjuvant chemotherapy improves survival in patients with colon carcinoma. To compare and understand the various chemotherapy trials, more stringent reporting of baseline laboratory values, performance status, and estimation of tumor involvement are needed.

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Adjuvant chemotherapy with 5-fluorouracil after surgical resection of colorectal carcinoma (COG protocol 7041)

Cited by 44 publications

References 14 publications

Patterns of recurrence of rectal cancer after potentially curative surgery

Patterns of recurrence of rectal cancer after potentially curative surgery

Adjuvant chemotherapy (CMF) for breast carcinoma: Hematological side effects

Role of chemotherapy in the treatment of colorectal carcinoma

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