ADJUVANT THERAPY FOR COLORECTAL-CANCER - STATUS 1998

Colorectal cancer is the second leading cause of cancer death in weste rn countries. The prognosis is strongly correlated to the TNM-staging system and patients with stage T3-4 and/or node positive disease are a t high risk for locoregional or distant relapse. It is now widely acce pted that patients with node positive colon cancer should be offered p ostoperative adjuvant chemotherapy. Evidence is accumulating that six months' adjuvant fluorouracil plus leucovorin is equivalent to twelve months' fluorouracil and levamisole, which reduces cancer related deat hs by more than 30%. Other adjuvant treatment approaches are periopera tive regional chemotherapy or monoclonal antibody treatment, and the r esults of trials comparing these different treatment options alone or in combination are eagerly awaited. In rectal cancer, the risk of loco regional recurrence can be more than 50% and this event is associated with a detrimental effect on quality of life. The technique of mesorec tal excision and the use of radiotherapy, alone or in combination with chemotherapy, have evolved as the most important measures for prevent ion of locoregional recurrence. In addition, chemotherapy has proven t o be effective in reducing metastatic relapse and prolonging survival. The timing of radiotherapy (pre- versus postoperative) and the optima l combination of chemotherapy with radiation are presently important r esearch issues in resected rectal cancer. In both colon and rectal can cer, a common theme emerging from the experience of the last few decad es is that administration of dose-intensive fluorouracil is key for th e success of adjuvant treatment.