Therapy of Colorectal Carcinoma: Present Status and Future Prospects

Surgery is the only established form of curative treatment in colorectal cancer; yet, surgery alone will benefit only patients with no evidence of distant metastases, and even within this group a proportion as high as 50–60% of the patients will eventually relapse and die from their disease. The Gastrointestinal Tumor Study Group has recently reported a significant improvement in disease-free intervals of survival in rectal carcinoma employing adjuvant chemoradiotherapy versus surgery alone. Newer ways of administering radiation therapy include perioperative irradiation and prophylactic liver irradiation. The treatment of disseminated disease has not seen real progress for years, after the demonstration of a definite but partial activity of 5FU. Recently some interest has been shown in attempts at metabolically modulating the activity of 5FU as a way to improve the clinical effectiveness of this drug. With high-dose folinic acid objective responses ranging from 6% to 32% have been reported; however, relevant side effects (mucositis) are also usually obtained.