IMPROVING ADJUVANT THERAPY FOR RECTAL-CANCER BY COMBINING PROTRACTED-INFUSION FLUOROURACIL WITH RADIATION-THERAPY AFTER CURATIVE SURGERY
IMPROVING ADJUVANT THERAPY FOR RECTAL-CANCER BY COMBINING PROTRACTED-INFUSION FLUOROURACIL WITH RADIATION-THERAPY AFTER CURATIVE SURGERY
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DOI：
10.1056/nejm199408253310803
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发表时间：
1994-08-25
影响因子：
158.5
通讯作者：
RICH, TA
中科院分区：
文献类型：
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作者：
OCONNELL, M;MARTENSON, JA;RICH, TA
背景术后放疗联合化疗加氟尿嘧啶加司莫司汀已被确定为降低肿瘤复发风险和提高复发或死亡高危直肠癌患者生存率的有效方法。我们试图确定是否可以通过在整个放射治疗期间延长输注氟尿嘧啶来提高化疗的疗效，以及省略司莫司汀是否可以减少化疗的毒性和延迟并发症而不降低其抗肿瘤疗效。660例TNM II期或III期直肠癌患者在盆腔术后放疗期间接受间歇性推注或长期静脉输注氟尿嘧啶。在盆腔放疗前后，均给予司莫司汀联合氟尿嘧啶或单用更大剂量氟尿嘧啶的全身化疗。存活患者的中位随访时间为46个月，长期输注氟尿嘧啶的患者复发时间显著延长（P = 0.01），生存率提高（P = 0.005）。没有证据表明接受司莫司汀联合氟尿嘧啶治疗的患者有有益的效果。盆腔放疗期间持续输注氟尿嘧啶可提高高危直肠癌患者术后综合治疗的效果。司莫司汀联合氟尿嘧啶并不比高剂量氟尿嘧啶单独全身给药更有效。
Background. The combination of radiation therapy and chemotherapy with fluorouracil plus semustine after surgery has been established as an effective approach to decreasing the risk of tumor relapse and improving survival in patients with rectal cancer who are at high risk for relapse or death. We sought to determine whether the efficacy of chemotherapy could be improved by administering fluorouracil by protracted infusion throughout the duration of radiation therapy and whether the omission of semustine would reduce the toxicity and delayed complications of chemotherapy without decreasing its antitumor efficacy.Methods. Six hundred sixty patients with TNM stage II or III rectal cancer received intermittent bolus injections or protracted venous infusions of fluorouracil during postoperative radiation to the pelvis. They also received systemic chemotherapy with semustine plus fluorouracil or with fluorouracil alone in a higher dose, both before and after the pelvic irradiation.Results. With a median follow-up of 46 months among surviving patients, patients who received a protracted infusion of fluorouracil had a significantly increased time to relapse (P = 0.01) and improved survival (P = 0.005). There was no evidence of a beneficial effect in the patients who received semustine plus fluorouracil.Conclusions. A protracted infusion of fluorouracil during pelvic irradiation improved the effect of combined-treatment postoperative adjuvant therapy in patients with high-risk rectal cancer. Semustine plus fluorouracil was not more effective than a higher dose of systemic fluorouracil given alone.