A month of postoperative radiotherapy preceded by radiosensitizing
boluses of fluorouracil (5-FU) slashed the recurrence rate and
markedly improved survival in patients with Dukes B and C rectal
cancer in a study from the Norwegian Adjuvant Rectal Cancer Project
Group, presented at the European Cancer Conference (ECCO-8).
"The effect is comparable to more prolonged, resource-demanding,
and toxic regimens, such as the 6-month and 18-month regimens
used in the United States today," said Dr. K. M. Tveit of
the Norwegian Radium Hospital, Oslo.
He called the regimen "a good alternative that can be recommended
in patients with a high probability of local recurrence and in
institutions where the local recurrence rate with surgery alone
is relatively high--more than 10%."
Subjects randomized to the experimental arm of this 144-patient
trial received 23 fractions of 2 Gy with a three-field technique,
starting 4 to 6 weeks after surgery. Patients were treated in
the prone position with a full bladder to minimize toxicity to
In an attempt to achieve an optimal interaction between fluorouracil
and radiation, fluorouracil doses of 500 or 750 mg were administered
30 minutes before radiotherapy fractions 1, 2, 11, 12, 21, and
Five-year relapse-free survival reached 64% in patients who underwent
adjuvant therapy, compared with 46% in the surgery-alone patients,
Dr. Tveit reported. Five-year overall survival was 64% in the
adjuvant therapy group and 49% in the control group.
The incidence of local recurrences, most of which were associated
with distant metastases, was only 12% in the adjuvant therapy
arm vs 30% in the control group, he said.
Except for three cases of grade 3 dermatitis, adjuvant therapy
was well tolerated, Dr. Tveit said, emphasizing that there was
no excess incidence of small bowel obstruction in the adjuvant