Skip to main content

Advertisement

SpringerLink
Log in

Bisherige entwicklungen und aktueller stand der adjuvanten chemo- und radiotherapie beim kolon- und rektumkarzinom

Developments and current status of adjuvant chemo-and radiotherapy for colorectal cancer

  • Originalarbeiten
  • Published:
Langenbecks Archiv für Chirurgie Aims and scope Submit manuscript

Abstract

A review is given of the historical and current concepts of adjuvant chemo- and radiotherapy of colorectal cancer. Early studies analyzing the use of single drug regimens were followed by a second study generation investigating adjuvant chemotherapeutic combinations. 5-FU proved to be the most efficient single drug investigated and 5-FU/MeCCNU/vincristin the most efficient chemotherapeutic combination, but no significant improvement in 5-year survival rates was achieved. Clear progress was noted with the introduction of levamisol (LEV) for modulation of 5-FU. A 33% improval in the 5-year survival rate in patients with stage III colon carcinoma was documented. It was therefore recommended (NIH consensus conference 1990) that all patients with stage III colon carcinoma be treated with this regimen unless admitted to other trials of adjuvant therapy. Preoperative radiotherapy with a dosage of 35–45 Gy can lead to downstaging of rectal cancer. Nevertheless, significant improvement in patient survival has not been proved convincingly using either isolated pre- or postoperative adjuvant radiotherapy. However, combined radiochemotherapy has been shown to improve both patient survival and local tumor control compared to surgical resection alone. It is therefore recommended that all stage II and III rectal cancer patients be treated with adjuvant combined radiochemotherapy. 5-FU/MeCCNU is currently expected to be the most efficient chemotherapy in combination with radiotherapy. Early data point out that MeCCNU could possibly be omitted. Intraoperative radiotherapy (IORT) allows further dosage escalation in order to improve local tumor control without affecting radiosensitive structures. Available data are still sparse and mostly based on the treatment of advanced carcinoma. A general validation of IORT is not yet possible, but current data are promising.

Zusammenfassung

In der Arbeit werden bisherige und aktuelle Konzepte der adjuvanten Chemo- und Radiotherapie in einer Übersicht dargestellt. Nach frühen Chemotherapiestudien mit systemischem Einsatz verschiedener Einzelsubstanzen folgten Versuche, die therapeutische Effizienz durch Wirkstoffkombinationen zu steigern. 5-FU erwies sich als relativ wirkungsvollste Einzelsubstanz, 5-FU/MeCCNU/Vincristin als wirksamste Kombination. Verbesserungen der Fünfjahresüberlebensraten konnten nur vereinzelt erzielt werden. Einen deuthchen Fortschritt erbrachte die Modulation der 5-FU-Wirkung durch Levamisol (LEV). Hierdurch wurde fur Kolonkarzinome im Stadium Dukes C eine Verbesserung der Fünfjahres-überlebensrate um 33% erzielt. Basierend auf diesen Daten wird empfohlen, alle Kolonkarzinompatienten im Stadium III mit 5-FU/LEV zu behandeln, soweit sie nicht einer aktuellen Adjuvansstudie zugeführt werden können. Der Empfehlung kann his heute noch keine weitere allgemeine Richtlinie hinzugefügt werden. Beim Rektumkarzinom kann durch prdoperative Radiotherapie ein Down-Staging nach Dosen von 35-45 Gy erzielt werden. Eine signifikant positive Beeinflussung der Überlebens-prognose ist jedoch weder durch eine alleinige prä- noch postoperative adjuvante Bestrahlung überzeugend dokumentiert. Demgegenüber konnten durch kombinierte postoperative Radio-Chemo-Therapien (5-FU/MeCCNU) sowohl verbesserte Überlebensraten als auch eine verbesserte lokale Tumorkontrolle im Vergleich mit der alleinigen Resektion aufgezeigt werden. Es besteht die Empfehlung, alle Rektumkarzinompatienten im Stadium II und III einer kombinierten Radio-Chemo-Therapie unter Studienbedingungen zuzuführen. Als effektivste Chemotherapie in Verbindung mit Radiatio gilt 5-FU/MeCCNU. Interimsergebnisse deuten jedoch darauf hin, daß MeCCNU verzichtbar ist. Die intraoperative Radiatio (IORT) erlaubt eine Dosiseskalation zur Optimierung der lokalen Tumorkontrolle bei maximaler Schonung strahlensensibler Strukturen. Bisher liegen noch wenig Ergebnisse vor. Eine generelle Wertung der IORT im Rahmen adjuvanter Konzepte ist noch nicht möglich. Die bisherigen Daten sind jedoch erfolgversprechend.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. NIH Consensus Conference (1990) Adjuvant therapy for patients with colon and rectal cancer. JAMA 264/11:1444–1450

    Google Scholar 

  2. Levitan N (1993) Chemotherapy in colorectal carcinoma. Surg Clin North Am 73/1:183–198

    Google Scholar 

  3. Donohue JH, Nelson H (1992) The current status of adjuvant therapy for colon cancer. Advances in surgery. Vol 25. Mosby Year Book, St. Louis, pp 223–257

    Google Scholar 

  4. Buyse M, Zeleniuch A, Chalmers TC (1988) Adjuvant therapy for colorectal cancer: Why we still don't know. JAMA 259:3571–3578

    Google Scholar 

  5. Moertel CG (1992) Accomplishments in surgical adjuvant therapy for large bowel cancer. Cancer 70/5 [Suppl]: 1364–1371

    Google Scholar 

  6. Moertel CG, Fleming TR, Mac Donald JS, Haller DG, Laurie JA, Goodman PJ, Ungerleider JS, Emerson WA, Tormey DC, Glick JH (1990) Levamisole and fluoruracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322:352–358

    Google Scholar 

  7. Moertel CG, Fleming TR, Mac Donald JS (1992) The intergroup study of fluoruracil in human colon cancer. A final report. Proc ASCO 11:161–165

    Google Scholar 

  8. Windle R, Bell PR, Shaw D (1987) Five year results of a randomized trial of adjuvant 5-fluoruracil and levamisole in colorectal cancer. Br J Surg 74:569–572

    Google Scholar 

  9. Bruckner MW (1991) Chemotherapy of advanced cancer of the colon and rectum. Sem Oncol 18/1:17–26

    Google Scholar 

  10. Poon MA, O'Connell MJ, Moertel CG, Wieand HS, Cullinan SA, Emerson LK, Krook JE, Maillard JA, Laurie JA, Tschetter LK (1989) Biochemical modulation of fluoruracil. Evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. J Clin Oncol 7/10: 1407–1418

    Google Scholar 

  11. Metzger U (1991) Adjuvant therapy for colorectal carcinoma. World J Surg 15:576–582

    Google Scholar 

  12. Cumings BJ (1992) Adjuvant radiation therapy for colorectal cancer. Cancer 70/5 [Suppl]:1372–1382

    Google Scholar 

  13. O'Connel MJ, Gunderson LL (1992) Adjuvant therapy for adenocarcinoma of the rectum. World J Surg 16:510–515

    Google Scholar 

  14. Cohen AM (1992) Adjuvant therapy in rectal cancer. Hepatogastroenterol 39:215–221

    Google Scholar 

  15. Mendenhall WM, Million RR, Bland KI, Pfaff WW, Copeland EM (1987) Initially unresectable rectal andenocarcinoma treated with preoperative irradiation and surgery. Ann Surg 205/1:41–44

    Google Scholar 

  16. Stockholm Rectal Cancer Study Group (1990) Preoperative short-term radiation therapy in operable rectal carcinoma. Cancer 66/1:49–55

    Google Scholar 

  17. Higgins GA, Conn JH, Jordan JH (1985) Preoperative radiotherapy for colorectal cancer. Ann Surg 191:624–631

    Google Scholar 

  18. Gerard A, Berrod JL, Pene F, Loygue J, Laugier A, Bruckner R, Camelot G, Arnaud JP, Metzger U, Buyse M (1988) Preoperative radiotherapy and radical surgery as combined treatment in rectal cancer. Recent Results Cancer Res 110:130–133

    Google Scholar 

  19. Tepper JE, Cohen AM, Wood WC, Orlow E, Hedberg SE (1987) Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys 13/1:5–10

    Google Scholar 

  20. Stevens KR, Allen CV, Fletcher WS (1976) Preoperative radiotherapy for adenocarcinoma of the rectosigmoid. Cancer 37/6:2866–2874

    Google Scholar 

  21. Minsky BD, Kemeny N, Cohen AM, Enker WE, Kelson DP, Reichmann B, Saltz L (1991) Preoperative high-dose Leucovorin/5-Fluoruracil and radiation therapy for unresectable rectal cancer. Cancer 67/1:2859–2866

    Google Scholar 

  22. Gunderson LL, Martenson JA, Devine RM, Wolff BG, Nivatvongs S, Pemberton JH, Beart RW (1990) Indications for and results of TORT with colorectal cancer. In: Abe M, Takahashi M (eds) Intraoperative radiation therapy; Proceedings of the third international symposium on intraoperative radiation therapy. Pergamon Press, New York, pp 299–305

    Google Scholar 

  23. Tepper JE, Cohen AM, Wood WC, Hedberg SE, Orlow E (1986) Intraoperative electron beam radiotherapy in the treatment of unresectable rectal cancer. Arch Surg 121:421–423

    Google Scholar 

  24. Willett CG, Shellito PC, Tepper JE, Eliseo R, Convery K, Wood WC (1990) Intraoperative electron beam radiation therapy for primary locally advanced rectal and rectosigmoid carcinoma. In: Abe M, Takahashi M (eds) Intraoperative radiation therapy; Proceedings of the third international symposium on intraoperative radiation therapy. Pergamon Press, New York, pp 305–311

    Google Scholar 

  25. O'Connell M, Wiland H, Krook J, Marenson J, Mac Donald J, Rich T et al (1991) Lack of value for McCCNU as a component of effective rectal cancer surgical adjuvant therapy. Am Soc Clin Oncol 10:134

    Google Scholar 

  26. Steele G jr (1992) Adjuvant therapy for patients with colon and rectal cancer. Clinical indications and multimodality therapy in high risk groups and specific surgical questions for future multimodality trials. Surgery 112/5:847–849

    Google Scholar 

  27. Hartung G, Dietzler P, Hagmüller E, Queißer W (1993) New approaches to adjuvant therapy of colorectal carcinoma including current german activities. Onkologie 16:416–424

    Google Scholar 

  28. Wolmark N, Fisher B, Rockette H, Redmond C, Wickerham DL, Fisher ER, Jones J, Lerner H, Lawrence W et al (1988) Postoperative adjuvant chemotherapy or BCG for colon cancer: Results from NASBP protocol C-01. J Natl Cancer Inst 80:30–36

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg

    T. W. Kraus

  2. Strahlenklinik, Ruprecht-Karls-Universität, Heidelberg

    M. J. Eble

  3. Medizinische Klinik, Ruprecht- Karls-Universität, Heidelberg

    U. Raeth

Authors
  1. T. W. Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. J. Eble
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Raeth
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kraus, T.W., Eble, M.J. & Raeth, U. Bisherige entwicklungen und aktueller stand der adjuvanten chemo- und radiotherapie beim kolon- und rektumkarzinom. Langenbecks Arch Chir 379, 353–357 (1994). https://doi.org/10.1007/BF00191582

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00191582

Key words

Search

Navigation