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Progress has been made in the adjuvant treatment of colorectal carcinoma.
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The improvement in survival with the use of adjuvant 5-FU and leucovorin in patients with stage III colon carcinoma has been
readily established. However, a survival benefit in stage II patients treated with adjuvant therapy remains unproven. Further
evaluation using additional/new prognostic factors may identify a high-risk stage II group that would benefit from adjuvant
treatment.
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Adjuvant chemoradiation has become standard therapy for stage II and III patients with rectal carcinoma. Investigations using
preoperative combined-modality therapy are being explored to assess sphincter preservation rates and to evaluate any impact
on survival. Radiosensitizing chemotherapeutic agents need to be evaluated in this patient population.
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Recent advances in metastatic disease have occurred. Frontline therapy remains 5-FU and leucovorin. CPT-11 has demonstrated
responses in 5-FU relapsed and refractory patients and is the new standard therapy in these patients. New data recently available
also show a survival advantage in patients treated with CPT-11 versus supportive care in 5-FU and leucovorin failures.
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New agents such as UFT and oxaliplatin have demonstrated activity in colorectal carcinomas and in the future these agents
will likely aid in the treatment of this disease.
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