GIVIO-SITAC 01

A randomized trial of adjuvant 5-fluorouracil and folinic acid administered to patients with colon carcinoma-long term results and evaluation of the indicators of health-related quality of life

Authors

  • Alberto Zaniboni M.D.,

    Corresponding author
    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
    • Via Gabriele Rosa 3, 25121, Brescia, Italy
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  • Roberto Labianca M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Silvia Marsoni M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Valter Torri M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Paola Mosconi M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Roberto Grilli M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Giovanni Apolone M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Stefania Cifani M.D.,

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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  • Angelo Tinazzi M.D.

    1. Modulo di Oncologia, Poliambulanza, Brescia, Italy; Divisione di Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; and Istituto Mario Negri, Milano, Italy
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Abstract

BACKGROUND

In 1989, the authors began a randomized trial to determine whether 5-fluorouracil and high dose folinic acid (HD-FUFA) would increase the event free and overall survival of patients with resectable Dukes B and C (AJCC/UICC Stage II and Stage III) colon carcinoma, and to assess the toxicity of the treatment and its impact on selected health-related quality-of-life indicators. Early results were published as a part of an international multicenter pooled analysis (IMPACT) in 1995. This purpose of this report is to update the survival data for patients enrolled in the trial and describe their reported perceptions of their own health and quality of life.

METHODS

The trial involved multiple treatment centers, with a centralized randomization between surgery alone and surgery with chemotherapy. The HD-FUFA regimen employed consisted of 5-fluorouracil (370-400 mg/m2) plus folinic acid (200 mg/m2) administered daily for 5 days every 4 weeks for 6 cycles. Patients' perceptions of their own health status were obtained by means of 3 self-administered questionnaires, which were completed by patients at the time of discharge from the treatment center and at 6 and 24 months after randomization.

RESULTS

Overall, 888 patients with resected Dukes B2 and C colon carcinoma were enrolled in the trial. HD-FUFA significantly reduced mortality by 25% (95% confidence interval, 5-41%; P = 0.02) and events by 31% (95% confidence interval, 14-45%; P ≤ 0.001). Compliance with treatment was good; more than 80% of patients completed the planned therapy. Toxicity was mild, and oral mucositis was the main side effect. None of the health-related quality-of-life parameters investigated (emotional status, worry about the future, changes in social life, impact of the disease, follow-up, and global quality of life) seemed to be affected by the treatment to which patients were allocated. A positive trend in the evolution of patients' psychologic status was observed.

CONCLUSIONS

Long term results of this SITAC study confirm that HD-FUFA is a well-tolerated, effective 6-month adjuvant regimen for patients with colon carcinoma that has no detrimental effect on their quality of life. Cancer 1998;82:2135-2144. © 1998 American Cancer Society.

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