Effective surgical adjuvant therapy for high-risk rectal carcinoma

Article Abstract:

Rectal cancer, which affects about 45,500 people in the United States each year, has a survival rate of 35 percent at five years, and 22 percent at 10 years. The addition of chemotherapy to surgical treatment has not produced better results. Rectal cancer tends to recur in the same area of the body, inducing physicians to try radiation therapy, which has lowered the rate of local recurrence, but has not improved survival. The use of radiation therapy has continued because it produces a degree of relief by reducing the probability of recurrence. Two hundred four patients with rectal cancer and a poor prognosis were given either chemotherapy (fluorouracil and semustine) and radiation or radiation alone after surgery. The patients were followed up for seven years. After seven years 111 patients had died, of whom 62 had received only radiation, and 49 received combination therapy. No patients died during this study from toxicity as a consequence of chemotherapy, but digestive problems, loss of white blood cells (leukopenia) and loss of blood platelets (thrombocytopenia), and other side effects were common. Ten patients had small-bowel obstruction, and two died from this complication. The rate of complications leading to death was only two percent, and thirteen patients had severe delayed reactions. Several patients did not receive the entire course of treatment for a variety of reasons, including side effects and refusal to continue participation. However, the combination of chemotherapy and radiation led to reduced recurrence and improved survival among these patients. It remains to be seen whether this advantage can be achieved by chemotherapy alone, or whether chemotherapy must be used in combination with radiation. It is likely that combination adjuvant therapy for rectal cancer will continue to improve as more effective systemic chemotherapy is developed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Radiotherapy

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Fluorouracil plus levamisole as effective adjuvent therapy after resection of stage III colon carcinoma: a final report

Article Abstract:

A combination of the drugs fluorouracil and levamisole may prevent recurrence of colon cancer that has been surgically removed. Recurrance rate improved by 40% and the death rate by 33% in a five-year follow up study of 929 patients who had undergone surgical removal of stage III (high risk) colon cancer and who had subsequently taken fluorouracil plus levamisole as chemotherapy. Side effects were reported to be manageable, and 70% of patients complied with the treatment regimen. This study is a follow up to a 1990 study which recommended fluorouracil plus levamisole following surgical removal of stage III colon cancer. The National Institutes of Health recommended this approach as standard therapy for patients with surgically treated stage III colon cancer after the 1990 study was published. The chemotherapeutic effect of fluorouracil may be enhanced by levamisole, which may explain why they work together well. Future research may show that fluorouracil plus leucovorin do equally well.

Levamisole

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Granulocyte colony-stimulating factor in severe chemotherapy induced afebrile neutropenia

Article Abstract:

Granulocyte colony-stimulating factor (G-CSF) may provide no benefit in cancer patients with neutropenia caused by chemotherapy. Neutropenia is a drop in the level of white blood cells called neutrophils. Of 138 patients with chemotherapy-induce neutropenia, 71 received daily injections of G-CSF and 67 received a placebo. Although neutrophil counts rose faster in those who received G-CSF, both groups had similar hospitalization rates, number of days in the hospital, use of antibiotics and incidence of infection.

Complications and side effects, Drug therapy, Granulocyte colony-stimulating factor, Neutropenia

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