title: Combined radiotherapy and chemotherapy in the treatment of gastrointestinal malignancies.
abstract: There has long been an interest in the use of combination chemotherapy/radiotherapy in the treatment of gastrointestinal tumors. Almost all such regimens combined 5-fluorouracil (5-FU) with radiotherapy. Work has been done in gastric cancer, pancreatic cancer, and colon and rectal cancer, all of which demonstrate an advantage in certain clinical situations for combined-modality therapy. In locally advanced pancreatic cancer, radiotherapy/5-FU has been shown to improve survival compared with radiotherapy alone, while in resectable carcinoma of the pancreas, the combination has been demonstrated to improve long-term survival compared with surgery alone. In patients with gastric cancer the data are more limited, but indications are that combined-modality therapy may benefit certain subsets of patients. Little information exists in colon cancer, but patterns of failure suggest a potential role for adjuvant radiotherapy/5-FU. Studies are being designed to test the hypothesis. In rectal cancer, a significant amount of data exists to support the value of radiotherapy/5-FU-based chemotherapy as an adjuvant in patients with stages B2 and C tumors. At present, studies are being run or analyzed to define whether modulation of 5-FU with leucovorin or levamisole, or whether the use of continuous infusion 5-FU, will improve the therapeutic efficacy of the adjuvant therapy.
authors.affiliation: Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill 27599-7512.
authors.forename: J E
authors.initials: JE
authors.lastname: Tepper
mesh_terms: D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D010190:Pancreatic Neoplasms / Q000628:therapy*; D012004:Rectal Neoplasms / Q000628:therapy*; D013274:Stomach Neoplasms / Q000628:therapy*
chemical_list: D005472:Fluorouracil