WESTPORT, May 01 (Reuters Health) - In patients with stage II colon cancer, intraperitoneal 5-fluorouracil, administered after resection and intravenous chemotherapy with 5-FU, can provide a significant reduction in the rate of local and distant recurrence, according to French investigators.
Dr. Bernard Nordlinger from Hopital Ambroise Pare, Boulogne, and a multicenter team studied 267 patients with stage II and stage III colon cancer. After resection, the researchers randomized patients into two groups.
In group one, 133 patients, received intraperitoneal administration of 5-FU for 6 days beginning 4 days after resection. The delivered dose was 0.6 g per square meter per day of 5-FU. These patients also had received 1 g of 5-FU during surgery. In group two, 134 patients underwent resection alone, according to the report.
Of the patients in group one, 103 received all 6 days of intraperitoneal 5-fluorouracil and 18 received a partial dose because of "technical or tolerance problems." Twelve patients did not receive chemotherapy.
After 58 months of follow-up "5-year overall survival rates were 74% in group one and 69% in group two; disease-free survival rates were 68% and 62%, respectively."
The researchers noted that among those who had received the full treatment, there was a significantly improved 5-year disease-free survival of 89% only for stage II patients. However, the 5-year disease-free survival rate of 73% was unchanged for the stage III patients.
"Tumor recurrences were observed in 33 patients (24.8%) in the 5-FU group and in 42 (31.3%) in the control group," they report in the April issue of the Annals of Surgery. Among the patients in the treatment group, only 4 had local recurrence of the disease compared with 11 in the control group. In addition, there was a delay in the appearance of liver metastases of 21 months in the treated patients, versus a delay of only 11 months in the controls.
"Locoregional chemotherapy is likely to act in patients in whom the disease is still confined to the abdomen," Dr. Nordlinger group points out. "This hypothesis is supported by the results of this study, in which improvement was observed only in patients with stage II cancers."
They also note that because systemic and intraperitoneal routes of administration for adjuvant chemotherapy have "different targets and different times of effect," the two approaches can well work in combination.