Treatment of advanced colorectal cancer (CRC) in daily practice: Results of a survey in two Italian regions, Piemonte and Valle d'Aosta

Aims and background: Colorectal cancer (CRC) is one of the most important h ealth problems in Western countries: it is the fourth cancer in terms of in cidence and the second cause of cancer death. Surgery is the main therapeut ic choice and there is broad consensus on the role of adjuvant chemotherapy (CT) after resection, Unfortunately, 50% of the patients will relapse and die of the disease. Palliative CT based on 5-fluorouracil (5FU) may induce a 9-48% response rate with a median survival of 11.5 months. At present the re is no gold standard for CT in advanced CRC and the situation has become more complicated since the advent of new drugs (Raltitrexed, Irinotecan, Ox aliplatin), The aim of this study was the identification of the different a pproaches to treatment of advanced CRC among the clinicians (oncologists, r adiologists, internal medicine specialists, surgeons) who practice CT. Meth ods and study design: Forty-six clinicians from two Italian Regions (Piemon te and Valle d'Aosta) were interviewed by telephone. Results: 5FU modulated with Lederfolin according to the classic Machover scheme is the main optio n in daily practice, More sophisticated therapies are reserved to patients with a good performance status (PS) and are prescribed only in the larger c enters. The planned therapies usually consist of six courses, Restaging may be performed after three or six courses. A marked difference has been reco rded in the evaluation of a situation of no change (NC): 25.5% Of the clini cians evaluate stable disease as a positive result, In the event of disease progression or relapse, 35% of the clinicians do not prescribe second-line CT. In case of further treatment, the options are totally subjective. Conc lusions: A national survey on this issue is necessary under the auspices of AIOM (Associazione Italians Oncologia Medica) and involving oncologists, e pidemiologists and statisticians, in order to define the reasons for variat ions in therapy in advanced CRC and determine the differences between clini cians of different age, specialization and location. This survey could lead to a definition of guidelines for the treatment of advanced CRC.