Colorectal cancer – Related resources

Cochrane reviews

• Postoperative adjuvant chemotherapy appears to improve disease free survival (DFS) in patients with rectal carcinoma and no preoperative radiation. Available data do not define whether the efficacy of this treatment is highest in one specific TNM stage.
• Chemotherapy prolongs both progression free survival and overall survival compared to best supportive care in patients with advanced or metastatic colorectal cancer .
• There is no unequivocal evidence that the quality of life after sphincter-preserving anterior resection for rectal cancer would be superior as compared to abdominoperineal excision with colostomy .
• Laparoscopic colorectal resection, as compared to conventional colorectal resection, appears to have clinically relevant advantages in selected patients under traditional perioperative treatment .
• Chemotherapy delivered via the hepatic artery following surgical resection of liver metastases arising from colorectal cancer may not improve survival .
• After low anterior resection for rectal cancer, coloanal reconstruction with the colonic J pouch leads to better bowel function up to 18 months postoperatively and similar rates of postoperative complications when compared to the straight coloanal anastomosis .
• Pre and peri-operative erythropoietin use seems not to decrease blood transfusions in colorectal cancer surgery, although the evidence is insufficient .
• Compared to preoperative radiotherapy alone, preoperative chemoradiation (CRT) may not increase overall survival or disease-free survival, although it enhances pathological response and improves local control in resectable stage II and III rectal cancer. The effects of preoperative CRT on functional outcome and quality of life are incompletely understood .
• Second-line chemotherapy is effective in prolonging time to progression and survival in patients with advanced colorectal cancer .
• Bevacizumab in combination with chemotherapy prolongs both progression-free and overall survival of patients with metastatic colorectal cancer, as compared to chemotherapy alone .
• Hyperthermia seems to have an additional effect when added to radiotherapy in the treatment of advanced rectal cancer although the evidence is insufficient. It is not known if this effect is as strong as the combination of chemotherapy and radiotherapy .
• Fluoropyrimidine hepatic arterial infusion for the treatment of patients with unresectable colorectal cancer liver metastases seems not to increase survival when compared with fluoropyrimidine-based systemic chemotherapy, although the evidence is insufficient .
• There is insufficient evidence on benefits and harms of selective internal radiation therapy (SIRT) in addition to chemotherapy in patients with colorectal cancer and metastasis in the liver .
• Shorter duration (3-6 months) of adjuvant chemotherapy for non-metastatic colorectal cancer is not associated with poorer relapse free survival or overall survival than longer duration (9-12 months) chemotherapy .
• Chemotherapy (both as single agent and in combination) prolongs progression free survival and overall survival in patients with advanced or metastatic colorectal cancer compared to best supportive care .

Other evidence summaries

• Portal vein infusion of 5-fluorouracil may produce an absolute improvement in 5-year survival of around 5% .
• HRT decreases the risk of colorectal cancer .
• Genetic testing of hereditary nonpolyposis colorectal cancer can reduce the number of surveillance colonoscopies and help target surveillance at high-risk patients .

Literature

Clinical practice reviews

• Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, Starling N. Colorectal cancer. Lancet 2010 Mar 20;375(9719):1030-47.
• Ballinger AB, Anggiansah V. Colorectal cancer. BMJ 2007;335:715-718

Other literature

• Figuerdo ym. Clin Oncol 2004;16:3395-407 tai Gill S ym Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and how much? J Clin Oncol 2004;10:1797-806
• Folkesson J, Birgisson H, Påhlman L, Cedermark B, Glimelius B, Gunnarson U. Swedish rectal cancer trial:long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005,235644-50
• Bosset JF, Collette L ym. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006,355:1114-23
• Gerard JP, Conroy T ym. Preoperative radiotherapy with and without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: Results of FFCD9203. J Clin Oncol 2006;24:4620-25