Up: Adjuvant Therapy
As the liver is the main site of metastatic disease, several
investigators have suggested that most of the benefit of adjuvant
therapy is from its effects on the liver. All of the commonly used
drugs cannot be given in oral form so that route to the liver is not
available. However, it is possible to implant a catheter at the time
of surgery into a small branch of the portal vein (eg in the mesentry
of the small bowel). Then the chemotherapy is administered via this
for 1 week post op.
This procedure was evaluated in the AXIS trial and was shown to add
about +5% benefit above the standard 5-FU and folinic acid regimen.
Adrian P. Ireland