[Prevention of hepatic metastases in radically operated colonic cancers]

The prognosis of colon cancer, after curative resection, is mainly related to the outcome of metastases, and especially of liver metastases. It is generally accepted that adjuvant medical therapy is important in order to prevent the incidence of metastatic recurrences. The aim of the present review is to analyse the conclusions of the main recent randomized trials assessing the comparative value of different adjuvant protocols. The results obtained using either systemic infusion, the classical one, or intraportal infusion, which is mainly designed to prevent liver metastases, are reported. On the basis of the review, we can conclude that: adjuvant chemotherapy using combined drugs (MF, MOF) did not prove to be more active than 5-FU alone. The beneficial action of a combined 5-FU + levamisole regimen has been clearly demonstrated for patients with a Dukes C tumour. According to a unique and limited trial, intraportal adjuvant therapy has been shown to be effective for patients with Dukes B tumours, but this remains to be confirmed. On the basis of the present data, new adjuvant programs using combined chemotherapeutic and immunotherapeutic coupounds, and combined systemic and loco-regional infusion, could be developed.