Treatment Of Primary Colorectal Cancer Research Articles

Should chemotherapy be used as a treatment of advanced colorectal carcinoma (ACC) in patients over 70 years of age?: Contra:

Colorectal cancer is predominantly a disease of the elderly, with over half of all deaths from this disease occurring in people over the age of 75 years [ 1 Silverberg E. Boring C.C. Squires T.S. Cancer statistics. CA Cancer J. Clin. 1990; 40: 9-26 Crossref PubMed Scopus (950) Google Scholar ]. Furthermore, the number of cases occurring in elderly people is expected to increase in the future as a result of population ageing. The primary treatment of colorectal cancer is surgical resection, but over half of all patients will eventually die of metastatic disease, which includes approximately 25% of patients who have evidence of metastases at the time of diagnosis [ 2 Cunningham D. Findlay M. The chemotherapy of colon cancer can no longer be ignored. Eur. J. Cancer. 1993; 29A: 2077-2079 Abstract Full Text PDF PubMed Scopus (94) Google Scholar ].

Detection and significance of minimal residual disease in colorectal cancer.

Colorectal cancer (CRC) is one of the most common causes of cancer death in the developed world. Although the primary treatment for CRC is surgical, disease relapse due to minimal residual disease (MRD) following apparently curative surgery occurs in up to fifty percent of patients. Most patients who develop overt metastases beyond the regional lymph nodes eventually die of the disease. At present adjuvant chemotherapy is used to improve survival in patients with metastases to regional lymph nodes demonstrated by routine histopathology with no other evidence of spread. The ability to identify metastatic disease at an earlier stage could be of considerable benefit in directing adjuvant therapy to patients at high risk of relapse who are not identified by current methods. Several techniques have been developed for the detection of MRD, including immunohistochemical and molecular methods, however their role in clinical practise is not yet established. The purpose of this paper is to review these techniques and their potential clinical use in the management of CRC.

The miniscule benefit of serial carcinoembryonic antigen monitoring after effective curative treatment for primary colorectal cancer

Background: Serial carcinoembryonic antigen (CEA) levels have been recommended to detect asymptomatic recurrent colorectal cancer and to facilitate curative additional therapy. This study was designed to investigate the outcome of additional treatment for recurrent cancer in patients undergoing primary colorectal cancer treatment in a specialty center and subsequent relapsing with an elevation in serum CEA. Study Design: Patients treated for their primary cancers at our institution whose followup included CEA monitoring and whose cancers subsequently recurred, were analyzed from a prospective database of almost 1,900 patients. CEA levels of ≥ 5 ng/mL were considered elevated for purposes of treatment results. One hundred sixty-three patients were suitable for analysis. Median followup before and after recurrence was 14 months and 16 months, respectively. Results: Fifty patients were able to undergo complete resection of their recurrence, and 26 of these patients are without evidence of recurrence at last followup. Two-thirds of recurrences were associated with an elevation of CEA; this elevation at recurrence was associated with decreased survival (p < 0.05, Kaplan Meier). Of the 109 patients with an elevation of CEA at recurrence, complete re-resection was accomplished in 26 patients. Of these, half remain cancer free. Of those with a normal CEA at recurrence, complete re-resection was feasible in 24 patients. Conclusions: Only 17% of patients with recurrent colorectal cancer undergoing potentially curative reresection have an elevated CEA. If we use the denominator of our patient population using an estimated relapse rate of 25–50%, the overall likelihood of CEA-directed curative re-resection confirms early estimates of less than a 5% survival advantage.

The Miniscule Benefit of Serial Carcinoembryonic Antigen Monitoring After Effective Curative Treatment for Primary Colorectal Cancer

Background: Serial carcinoembryonic antigen (CEA) levels have been recommended to detect asymptomatic recurrent colorectal cancer and to facilitate curative additional therapy. This study was designed to investigate the outcome of additional treatment for recurrent cancer in patients undergoing primary colorectal cancer treatment in a specialty center and subsequent relapsing with an elevation in serum CEA. Study Design: Patients treated for their primary cancers at our institution whose followup included CEA monitoring and whose cancers subsequently recurred, were analyzed from a prospective database of almost 1,900 patients. CEA levels of ≥ 5 ng/mL were considered elevated for purposes of treatment results. One hundred sixty-three patients were suitable for analysis. Median followup before and after recurrence was 14 months and 16 months, respectively. Results: Fifty patients were able to undergo complete resection of their recurrence, and 26 of these patients are without evidence of recurrence at last followup. Two-thirds of recurrences were associated with an elevation of CEA; this elevation at recurrence was associated with decreased survival (p < 0.05, Kaplan Meier). Of the 109 patients with an elevation of CEA at recurrence, complete re-resection was accomplished in 26 patients. Of these, half remain cancer free. Of those with a normal CEA at recurrence, complete re-resection was feasible in 24 patients. Conclusions: Only 17% of patients with recurrent colorectal cancer undergoing potentially curative reresection have an elevated CEA. If we use the denominator of our patient population using an estimated relapse rate of 25–50%, the overall likelihood of CEA-directedcurativere-resection confirms early estimates of less than a 5% survival advantage.

Long-term benefits of aggressive treatment for primary colorectal cancer

The long-term follow up of 128 colorectal cancer patients is reported. Seventy-nine percent (101/128) of the patients had curative resections: 70 patients had radical lymphadenectomies with wide removal of tumor-adjacent nodes, and 31 patients had standard resections. The 5-year overall survival rates for Dukes' stage B and C patients and for all rectosigmoid cancer patients significantly favored radical resection (60% vs. 38%, 57% vs. 29%, respectively, P < 0.05). Tumor-free survival rates were also higher after radical lymphadenectomy but did not reach statistical significance. Eleven percent (14/128) of the patients required multiorgan resections, and/or preoperative radiation to render fixed cancers resectable, and these patients had a 10-year tumor-free survival rate of 45%, compared to zero % 5-year survival for the 27 patients who underwent palliative procedures (P < 0.01). These results confirm that many colorectal cancer patients will be cured with aggressive treatment and they support the need for a controlled trial for evaluation of lymphadenectomy for this disease.

Colorectal Cancer: Surgery for cancer of the colon and rectum

Surgery is the cornerstone of treatment of primary colorectal cancer, independent of the patients age and extent of disease. In the case of locoregionally confined tumors, an en-bloc resection of the primary tumor and adequate lymph node dissection should be performed. However, this is still not generally done. A subtle surgical technique is the most important prophylaxis against local recurrences. Standardized operative techniques, extended resections and perioperative measures led to a reduction of the rate of palliative resections and to a reduction of perioperative mortality (approximately 3%). However, despite modern surgical approaches, the long term prognosis of patients with stage II/III was not essentially improved. Therefore, especially in these stages, a further improvement of the current situation can at best expected by perioperative chemotherapy +/-irradiation.

EVALUATION OF POSTOPERATIVE UPPER GASTROINTESTINAL HEMORRHAGE IN PRIMARY COLORECTAL CANCER

This paper describes upper gastrointestinal hemorrhage after surgical treatment of primary colorectal cancer. During the past six years, operations have been carried out on 127 patients with primary colorectal cancer. Of these, 13 patients (10%) had postoperative bleeding from the upper gastrointestinal tract. This type of bleeding occurred in 5 (26%) of 19 patients undergoing urgent surgery. With regard to the operation methods, low anterior resection and colostomy frequently induced postoperative hemorrhage, in 3 of 11 cases (27%) and 4 of 15 cases (27%) respectively; however, abdomioperineal rectal amputation did not give rise to such bleeding in any of 23 cases. Gastrointestinal hemorrhage was also noted in 4 of 11 patients having diabetes mellitus as a preoperative complication; 2 of the 4 died. This arouses prognostic concern.Of the 13 cases with postoperative gastrointestinal hemorrhage, 10 were relieved with conservative hemostasis.Therefore, prophylactic administration of Cimetidine seems to be effective in the high-risk group for postoperative gastrointestinal hemorrhage.

Palliative resections in the treatment of primary colorectal cancer

Seventy-eight patients underwent palliative resections for adenocarcinoma of the colon or rectum. The operative mortality was 6.4 per cent. The high morbidity rate of 43.5 per cent, mostly attributable to errors in operative technic and sepsis, could not be related to the extent of tumor spread. In fifty-nine patients long-term follow-up revealed a mean survival time of 12.4 months and a median of 9.1 months. Thirty-eight patients (64.4 per cent) survived six months, twenty patients (33.8 per cent) one year, seven patients two years, and one patient five years. Patients with only local extension of disease had the most favorable duration of survival. Hepatic or peritoneal involvement alone did not preclude long-term survival, but with the two combined the outlook was less favorable. There is a small group of patients with extensive metastatic disease who will not benefit from resection. Otherwise, adenocarcinoma of the colon or rectum with local or distant metastases should be resected when feasible.