Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
5-Flourouracil (5-FU) is the best agent for the treatment of all gastrointestinal cancers but should be used with restraint, since severe toxicity does not guarantee increased response or survival time. Experimental work suggests that glucose enhances cellular uptake of 5-FU. Alkylating agents are definitely useful and occasionally produce long-term responses. Mitomycin C shows activity but is not available. There are reports of responses to methotrexate, vinca alkaloids, and mithramycin, but their place in the management of gastrointestinal cancer is not established. The usefulness of alkylating agents or 5-FU as adjuvants to surgery is not clear, but evidence is accumulating which supports the adjuvant use of 5-FU when disease is left behind. There is laboratory evidence that anticoagulation can prevent tumor recurrence, and this should be studied further. The best combination chemotherapy has not been determined. Regional chemotherapy offers a logical approach, but comparative data with systemic treatment are lacking, although techniques for protracted infusion, particularly of primary and secondary hepatic tumors, may justify its increased use. Wound washing with available contact tumoricidal agents is contraindicated, as it may increase local recurrence.
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