Intraportal fluorouracil for colorectal cancer

In 1989, the UK Coordinating Committee on Cancer Research identified improving survival of colorectal cancer patients as a national priority, and set up a working group to develop trial proposals. This group conducted a systematic review [14] of published adjuvant chemotherapy trials, and also contacted other trials organisations to find out about ongoing trials and to obtain, where possible, unpublished data. This review identified portal vein infusion of fluorouracil given immediately post-operatively for one week as a highly promising treatment; six trials had evaluated this treatment and together they suggested a striking, and highly statistically significant, reduction in the annual odds of death. However, the total number of patients included in the trials was only 1500 (only 300 of whom had died) and a high proportion of randomized patients were excluded from the published analyses which may have biased results in favour of chemotherapy (see Section 9.4.1). The data were therefore considered promising, but inconclusive, and led to the design of AXIS (Adjuvant X-ray and 5FU Infusion Study), a 4000-patient trial powered to look for modest but clinically worthwhile improvements in survival through the use of intraportal fluorouracil [15].

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