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Gastrointestinal Oncology - part 2

Các khối u tiêu hóa Study Group được công bố một thử nghiệm tích cực tìm kiếm tại methylCCNU với 5-FU.128 Sự sống còn trung bình là 33 tháng trong những người đã không nhận được hóa trị liệu sau phẫu thuật | 30 Chapter 3 chemotherapy but more recently the Intergroup 0116 Study reported information with improved disease-free and overall survival with combination chemoradiotherapy which will be discussed in detail subsquently.127 Initial adjuvant chemotherapy trials revealed less than encouraging data. The Gastrointestinal Tumor Study Group published a positive trial looking at methyl-CCNU with 5-FU.128 The median survival was reported at 33 months in those who did not receive postoperative chemotherapy the median survival in the chemotherapy arm was more than 4 years. Unfortunately these results were not confirmed in a larger trial setting. Mitomycin C was used by the Japanese Surgical Adjuvant Chemotherapy Group with various dosing schedules all trials but one were negative.129 Multiple adjuvant trials have been conducted in Japan unfortunately few had surgery alone as a control arm and many of these trials merely compared chemotherapy regimens. Several studies in the United States and Europe looked at regimens such as FAM and did compare surgery alone as the control most were negative trials with sufficient numbers of patients enrolled. Several meta-analyses have attempted to prove or disprove the use of adjuvant chemotherapy by creating larger sample sizes. One study published by the Dutch based on 14 randomized trials including 2096 patients did not suggest a survival advantage from adjuvant chemotherapy.130 Another meta-analysis in 1999 analyzed 13 trials demonstrating a small but significant survival benefit for patients receiving postoperative chemotherapy.131 There was an absolute risk reduction from 65 to 61 in relapse-free survival after postoperative chemotherapy. A third meta-analysis based on 20 trials was published by the Gruppo Italiano per lo Studio dei Carcinomi dell Apparato Digerente GISCAD . Patients received either 5-FU alone or in combination with adri-amycin-based chemotherapy with a reduced risk of death of 18 in the chemotherapy arm.132 This .