In this review new approaches to adjuvant therapy of colon and rectum carcinomas are reported. Early trials in the 70s using 5-fluorouracil and other monotherapies did not show any advantage for prognosis. The use of combination chemotherapy (e.g. 5-fluorouracil + methyl-CCNU) in several prospective trials suggested a considerable increase of late neoplasia. A statistically significant prolongation of recurrence-free survival and overall survival for patients with high-risk colon carcinoma (Dukes C) was first seen by combination of 5-fluorouracil with levamisole. Data of a first multicenter trial were recently confirmed by a larger series. For rectum carcinoma postoperative radiation therapy, effective for reduction of local recurrences, was included in adjuvant chemotherapy in several studies suggesting a statistically significant advantage of recurrence and overall survival. Recent data and analyses indicate that the combination of 5-fluorouracil and folinic acid, which shows high efficacy in advanced stages of colorectal carcinoma, is effective in the adjuvant setting too. During 1992/1993 in Germany five multicenter, prospective randomized trials were activated to clarify further details of this new prophylactic treatmenl possibility for colorectal carcinoma.

Keywords:
Colon and rectum carcinoma, Adjuvant therapy, 5-Fluorouracil, Levamisole, Folinic acid, Adjuvant irradiation
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© 1993 S. Karger AG, Basel
1993
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