The impact of 5-FU-based bolus chemotherapy on survival in patients with advanced colorectal cancer

Background: An analysis was performed to evaluate whether bolus chemotherap y with 5-fluorouracil (5-FU) and leucovorin (LV) improves survival for pati ents with advanced colorectal cancer (ACC). Patients and methods: Two group s of patients were selected from a database which included all patients wit h colorectal cancer treated in our hospital since 1984. The first group con sisted of all patients with irresectable metastases diagnosed between Janua ry 1984 and December 1989, who had a performance status of 0 or 1, and were younger than 76 years old. The second group consisted of all patients with irresectable metastases - younger than 76 years old and with a performance status of 0 or 1- who were started on chemotherapy between January 1994 an d December 1997. In the first period chemotherapy was never given and in th e second period chemotherapy was given to all motivated patients. None of t he patients had received a previous metastasectomy or isolated liver perfus ion. For chemotherapy, age, location of the metastases, type of surgical in tervention for the primary tumor, Hemoglobin, Lactate Dehydrogenase and Car cinoembryonic Antigen concentration we evaluated the relationship with surv ival. Variables which showed a significant relation with survival in the un ivariant analysis (logrank test, p < 0.05) were entered into a proportional hazards regression analysis. Results: In the univariant analysis chemother apy and location of metastases showed a significant relation with survival. The median survival was 11 months for patients who had received chemothera py and 8 months for untreated patients (p = 0.009). Chemotherapy and locati on of metastases both retained their significance in a proportional hazards regression analysis. Conclusion: In our study group chemotherapy added 3 m onths to the median life expectancy for patients with ACC.