EARLY HEMATOLOGICAL TOXICITY OF ADJUVANT PERIOPERATIVE INTRAPORTAL AND INTRAVENOUS CHEMOTHERAPY WITH FLUOROURACIL, MITOMYCIN AND HEPARIN INCOLORECTAL-CANCER

Background: From 1987 to 1993 the Swiss Group for Clinical Cancer Rese arch (SAKK) performed a randomized phase III adjuvant trial in patient s with colorectal adenocarcinoma with the objective of comparing intra portal versus intravenous perioperative chemotherapy. Patients and met hods: Patients younger than 75 years had a curative en bloc resection of their cancer and were then randomized into three arms: 1. adjuvant perioperative portal liver infusion with fluorouracil, mitomycin and h eparin, 2. adjuvant subclavian intravenous infusion with the same regi men and 3. no adjuvant treatment. The hematological toxicity was evalu ated by hemoglobin determination and leucocyte and thrombocyte countin g before and during ten days after surgery. Results: Hemoglobin showed a median decrease of 22% in the control group. This decrease is aggra vated significantly by 3% through the chemotherapy. Leucocytes showed a median decrease of 7% in the control group. Perioperative chemothera py caused a significantly higher median drop: 23% when given into the liver through a subclavian catheter. Thrombocytes revealed a median de crease of 25% in the control group. Chemotherapy was not associated wi th a significant additional drop. Conclusions: Adjuvant perioperative chemotherapy with fluorouracil, mitomycin and Heparin as given in this study is associated with a significant mild drop in hemoglobin and le ucocytes during the first 10 postoperative days. If drug dose increase s are planned in future trials the addition of hematopoietic growth fa ctors might be considered.