Adjuvant treatment in colorectal cancer. Experience from a referral center in eastern peninsular Malaysia.

BACKGROUND: Colorectal cancer is one of the most common malignancies in the West, but in Asia the incidence is low. However in Malaysia, colorectal cancer is increasing with a reported figure of 15% of all cancer cases. Adjuvant chemo and radiotherapy are now more frequently used in such patients. The present retrospective analysis was performed to document the effect of such therapy among patients with colorectal cancer in Malaysia. MATERIALS AND METHODS: This is a retrospective study on the use of adjuvant treatment in colorectal cancers. Patients with histopathological evidence of risk factors were subjected to adjuvant radiotherapy and/or chemotherapy. Cancers confined to rectum and rectosigmoid were subjected to pelvic radiotherapy to a tumor dose of 45 Gy in 20 fractions over 4-week period. 5-flurouracil based chemotherapy was predominantly offered for colonic cancers. RESULTS: One hundred thirty patients with colorectal cancers received adjuvant treatment with a median age of 58 years (range 22-76 years). The male to female ratio was 1.4:1. There were 76% Malays, 19% Chinese, 2% Indians and 3% Siamese subjects in this study. Modified Dukes' stage B2 (28%) and C (38%) constituted the majority, which were distributed in rectum (40%), rectosigmoid (19%), and in the remaining colon (41%). Thirty-one patients received 5-fluorouracil with folinic acid based regime and 35 patients received 5-fluorouracil with levamisole based regimen. Locoregional radiotherapy was offered to 56 (43%) patients. Following treatment, the 2-year actuarial survival was 28% and 54% in colon and rectum cancer respectively. CONCLUSIONS: This study showed that colorectal cancer is not infrequent among Malays in this region and rectal cancers had better survival than the colonic cancers.