Abstract
PURPOSE: This analysis was undertaken to assess whole abdomen radiation therapy and concurrent 5-fluorouracil for toxicity and patterns of failure in high-risk colon cancer patients after curative surgical resection. METHODS: Eighteen patients were treated adjuvantly after curative resection. Four patients (22 percent) had Stage B and 14 (78 percent) had Stage C disease. Histology was poorly differentiated in 4 (22 percent) and moderately differentiated in 14 (78 percent) patients. Four patients received whole abdominal radiation only, 30 Gy at 1 Gy/day. Fourteen patients had an additional locoregional boost of 9.6 to 16 Gy at 1.6 Gy/day. The liver received 19.8 Gy at 0.67 Gy/day. 5-Fluorouracil was given as a continuous infusion during therapy. RESULTS: With a median follow-up of three years, 6 of 18 (33 percent) patients have relapsed. Failure occurred locally in 3 of 18 (17 percent) and distantly in 4 of 18 patients (22 percent). Four of six (67 percent) failures occurred in the liver. The five-year actuarial survival and disease-free survival were 78 percent and 66 percent, respectively. Median elapsed time on radiotherapy was 73 days, with 5 of 18 patients (28 percent) requiring two or more weeks of unplanned treatment breaks. Acute Grade 3 to 4 toxicity (diarrhea, leukopenia) occurred in 3 of 18 patients (17 percent), with late complications (bowel obstruction) occurring in 2 of 18 patients (11 percent). CONCLUSIONS: Whole abdominal radiotherapy with concomitant 5-fluorouracil appears to improve local control but not to prevent liver metastases. Significant toxicity resulted in frequent interruption of therapy and protracted its course. Whether this adjuvant regimen impacts on survival or offers an advantage over locoregional irradiation remains to be studied.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Minski BD, Mies C, Rich TA, Recht A, Chaffey JT. Potentially curative surgery of colon cancer: patterns of failure and survival. J Clin Oncol 1988;6:106–18.
Willett CG, Tepper JE, Cohen AM, Orlow E, Welch CE. Failure patterns following curative resection of colonic carcinoma. Ann Surg 1984;200:685–90.
Laurie JA, Mortel CG, Fleming TR,et al. Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. J Clin Oncol 1989;7:1447–56.
Mortel CG, Fleming TR, MacDonald JS,et al. Levamisol and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990;322:352–8.
Wong CS, Harwood AR, Cummings BJ, Keane TJ, Thomas GM, Rider WD. Post-operative local abdominal irradiation for cancer of the colon above the peritoneal reflection. Int J Radiat Oncol Biol Phys 1985;11:2067–71.
Duttenhaver JR, Hoskins RB, Gunderson LL,et al. Adjuvant postoperative radiation therapy in the management of adenocarcinoma of the colon. Cancer 1986;57:955–63.
Shehata WM, Meyer RL, Jazy FK,et al. Regional adjuvant irradiation for adenocarcinoma of the cecum. Int J Radiat Oncol Biol Phys 1987;13:843–6.
Loeffler RK. Postoperative radiation therapy for adenocarcinoma of the cecum using two fractions/day. Int J Radiat Oncol Biol Phys 1984;10:1881–3.
Willett CG, Tepper JE, Shelito PC,et al. Indications for adjuvant radiotherapy in extrapelvic colonic carcinoma. Oncology 1989;3:3:25–33.
Ghossien NA, Samala EC, Alpert S. Elective postoperative radiotherapy after incomplete resection of colorectal cancer. Dis Colon Rectum 1981;24:252–6.
Meek AG, Lam WC, Order SE. Carcinoma of the colon: Irradiation by delayed split whole-abdomen technique. Radiology 1983;148:485–7.
Brenner HJ, Bibi C, Chaitchik S. Adjuvant therapy for Dukes C adenocarcinoma of the colon. Int J Radiat Oncol Biol Phys 1983;9:1789–92.
Fabian CJ, Reddy E, Jewell W,et al. Phase I–II pilot of AU whole abdomen radiation and concomitant 5-FU as an adjuvant in colon cancer: a Southwest Oncology Group Study. Int J Radiat Oncol Biol Phys 1988;15:885–92.
Fletcher GH. Clinical dose-response curves of human malignant epithelial tumors. Br J Radiol 1973;46:1–12.
Byfield JE, Calabro-Jones P, Klisak I, Kulhanian F. Pharmacological requirements for obtaining sensitization of human tumor cellsin vitro to combined 5-fluorouracil or ftorafur and x-rays. Int J Radiat Oncol Biol Phys 1982;8:1923–33.
Vietti T, Eggerdig F, Valeriote F. Combined effect of x-radiation and 5-fluorouracil on survival transplanted leukemic cells. J Natl Cancer Inst 1971;47:865–70.
Gastrointestinal Tumor Study Group. Adjuvant therapy with hepatic irradiation plus fluorouracil in colon carcinoma. Int J Radiat Oncol Biol Phys 1991;21:1151–6.
Drewinko B, Yand LY, Romsdahl MM. Radiation response of human carcinoembryonic antigen producing colon adenocarcinoma cells. Int J Radiat Oncol Biol Phys 1977;2L:1104–14.
Fertil B, Deschavanne PJ, Lachet B, Malaise EP.In vitro radiosensitivity of six human cell lines: a comparative study with different statistical models. Radiat Res 1980;82:297–309.
Ingold JA, Reed GB, Kaplan HS, Bagshaw MA. Radiation hepatitis. AJR 1965;93:200–8.
Rotman M, Kuruvilla MA, Choi K,et al. Response of colo-rectal hepatic metastases to concomitant radiotherapy and intravenous infusion 5-fluorouracil. Int J Radiat Oncol Biol Phys 1986;12:2174–87.
Kong JS, Peters LJ, Wharton TJ,et al. Hyperfractionated split-course whole abdominal radiotherapy for ovarian carcinoma: tolerance and toxicity. Int J Radiat Oncol Biol Phys 1988;14:737–43.
Morgan L, Chafe W, Mendenhall W, Marcus R. Hyperfractionation of whole-abdomen radiation therapy: salvage treatment of persistent ovarian carcinoma following chemotherapy. Gynecol Oncol 1988;31:122–34.
Author information
Authors and Affiliations
About this article
Cite this article
Ben-Josef, E., Court, W.S. Whole abdominal radiotherapy and concomitant 5-fluorouracil as adjuvant therapy in advanced colon cancer. Dis Colon Rectum 38, 1088–1092 (1995). https://doi.org/10.1007/BF02133984
Issue Date:
DOI: https://doi.org/10.1007/BF02133984