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INTRODUCTION
Malignancies of the gastrointestinal tract account for one quarter of all new visceral cancers and one third of all cancer deaths in the United States. Colorectal cancer accounts for 60% of these cases followed by stomach (14%), pancreas (13%), hepatobiliary (7%), esophagus (5%) and small intestine (1%). Each year, these malignancies account for over 200,000 new cases of cancer in the United States, annually resulting in more than 100,000 deaths (1). High mortality seen with colorectal cancer is predominantly due to either advanced stage of the disease at the time of diagnosis or development of metastases after initial potentially curative surgery. Metastatic disease develops in nearly half of all patients. These patients are candidates for chemotherapy. Chemotherapy, however, has not been very successful in the management of locally-advanced or metastatic gastrointestinal tract tumors. Many cytotoxic agents have been tried but none appears to be more effective than 5-Fluorouracil (5-FU). Generally, response rate to chemotherapy is low, duration of response is short, and there is no improvement in overall survival (2). On the other hand, 5-FU therapy with radiation and levamisole for recto-sigmoid and colonic cancers respectively has been shown to improve survival in certain subset of patients. The purpose of this paper is to review the role of chemotherapy in the management of localized as well as widespread colorectal cancer with a particular reference to the role of 5-FU and different means to modulate its efficacy.
Recent advances in the chemotherapeutic management of colorectal cancer
