EXPERIENCES IN ADJUVANT AND NEOADJUVANT THERAPY OF POTENTIALLY CURATIVE RESECTED RECURRENT COLORECTAL-CARCINOMA

Background: The adjuvant chemotherapy of colorectal carcinomas with 5- fluorouracil and levamisole or folinic acid has been shown to be effec tive in numerous clinical trials and is generally accepted for high-ri sk patients with stage Dukes BZ (T4, N0, M0) and C (any T, N1-3, MO) c arcinoma. Patients with resectable metastatic disease at the time of p rimary surgery or later are also at high risk for recurrence after com plete and potentially curative resection of metastases. We examined th e effect of adjuvant chemotherapy with 5-flourouracil and folinic acid on disease-free and overall survival as well as therapy-related toxic side effects in patients with potentially curatively resected colorec tal metastases. Patients and methods: Twenty patients with potentially curative resection of metastases or local recurrences from colorectal carcinoma were included into the analysis. Chemotherapy with 5-fluoro uracil and folinic acid in addition to local radiation for patients at risk for local recurrence was administered. Chemotherapy consisted of 450 mg/m(2) 5-fluorouracil and 100 mg/m(2) folinic acid given either once a week or at five consecutive days once a month. Treatment was co ntinued for a total of 12 months. In case of combined radio-/chemother apy the duration of treatment was reduced to 6 months and the dose was reduced to 350 mg/m(2) ti-fluorouracil during radiation. Results: Ana lysis of toxicity shows a low rate of side effects. Modest gastrointes tinal toxicity occurred most often, generally grade WHO I-it, one grad e-ill diarrhea was documented, grade IV-toxicity was not seen. The med ian disease-free interval after surgical resection of metastases was 1 3 months, the survival rate after two years was 85%. The 2-year-surviv al rate after resection of the primary tumour was 90%, the median surv ival was 59 months. Four patients were treated neoadjuvantly. They sho wed a long overall and disease-free survival (35 and 50 months). The r ate of secondary tumour relapse was 55%. Seven out of 11 patients had a tumour relapse at the side of the primary metastases. Median follow- up was 24 months (4 to 46 months after onset of adjuvant therapy). Con clusion: Compared to patients who did not receive adjuvant treatment a fter resection of metastases, disease-free and overall survival seem t o be superior after adjuvant treatment, especially in patients who als o received neoadjuvant therapy. However, these results need to be conf irmed by larger prospectively randomized phase-ill-trials.