Postoperative Adjuvant 5-Fluorouracil plus Levamisole Chemotherapy for Stage III Colon Carcinoma: 7-Year Experience in a Single Institution

CC Law, YT Fu

Hong Kong J Radiol 2002;5:97-104

Objectives: To determine the therapeutic efficacy and toxicity of 5-fluorouracil plus levamisole as postoperative adjuvant therapy for stage III colon carcinoma, and to identify prognostic variables.

Materials and Methods: A retrospective review was undertaken of 168 patients registered in our institution from January 1991 to December 1997 with completely resected stage III colon adenocarcinoma, who received postoperative adjuvant 5-fluorouracil plus levamisole. Data regarding demographics, pathological characteristics, relapse pattern, survival, and treatment toxicity were compiled and analysed.

Results: With a median follow-up of 48 months, 72/168 stage III colon carcinoma patients relapsed. Distant metastasis was the predominant mode of failure, with liver being the most common site. 90% of relapses occurred within 3 years of diagnosis. Five-year disease-free survival was 54%. and overall survival was 71%. Grade 3 chemotherapy toxicity was apparent in 0 to 1.8% of patients. No grade 4 toxicity was noted. The most common adverse effect was nausea, followed by thrombocytopenia and diarrhoea. Number of involved nodes and bowel obstruction were independent predictors for disease-free survival. Tumour site, number of involved nodes, and bowel obstruction were independent variables predictive of overall survival.

Conclusion: Postoperative adjuvant therapy with 5-fluorouracil plus levamisole is well tolerated and produces favourable outcomes for patients with stage III colon carcinoma. Less nodal involvement and the absence of bowel obstruction are independent positive predictors of disease-free or overall survival, in addition to tumour site.