title: Adjuvant chemotherapy in colorectal cancer: a joint analysis of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group.
abstract: Due to uncertainties regarding clinically meaningful gains from adjuvant chemotherapy after colorectal cancer surgery, several Nordic Groups in the early 1990s initiated randomised trials to prove or reject such gains. This report gives the joint analyses after a minimum 5-year follow-up. Between October 1991 and December 1997, 2 224 patients under 76 years of age with colorectal cancer stages II and III were randomised to surgery alone (n = 1 121) or adjuvant chemotherapy (n = 1 103) which varied between trials (5FU/levamisole for 12 months, n = 444; 5FU/leucovorin for 4-5 months according to either a modified Mayo Clinic schedule (n = 262) or the Nordic schedule (n = 397). Some centres also randomised patients treated with 5FU/leucovorin to+/-levamisole). A total of 812 patients had colon cancer stage II, 708 colon cancer stage III, 323 rectal cancer stage II and 368 rectal cancer stage III. All analyses were according to intention-to-treat. No statistically significant difference in overall survival, stratified for country or region, could be found in any group of patients according to stage or site. In colon cancer stage III, an absolute difference of 7% (p = 0.15), favouring chemotherapy, was seen. The present analyses corroborate a small but clinically meaningful survival gain from adjuvant chemotherapy in colon cancer stage III, but not in the other presentations.
authors.affiliation: Department of Oncology, Radiology and Clinical Immunology, University Hospital, Uppsala, Sweden. bengt.glimelius@onkologi.uu.se
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Björn
authors.initials: B
authors.lastname: Cedermark
authors.forename: Anders
authors.initials: A
authors.lastname: Jakobsen
authors.forename: Søren M
authors.initials: SM
authors.lastname: Bentzen
authors.forename: Hans
authors.initials: H
authors.lastname: Starkhammar
authors.forename: Henrik
authors.initials: H
authors.lastname: Grönberg
authors.forename: Ragnar
authors.initials: R
authors.lastname: Hultborn
authors.forename: Maria
authors.initials: M
authors.lastname: Albertsson
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
authors.forename: Kjell-Magne
authors.initials: KM
authors.lastname: Tveit
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D007978:Levamisole / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate
chemical_list: D007978:Levamisole; D002955:Leucovorin; D005472:Fluorouracil