Combination therapy of colorectal carcinoma.

The aim of the study was to optimise the present therapy for colorectal carcinoma according to the standard therapeutic protocol. At the Ist Department of Surgery of the LF MU St. Anna Hospital in Brno and at the Department of Radiation Oncology of the same hospital, 262 patients with colorectal carcinoma were treated in period 2000-2002. Neoadjuvant radiotherapy concomitant with chemotherapy was applied for 5-6 weeks. After this procedure, a 5-6-week break, the restaging and the surgical intervention have followed. A radical surgical operation was carried out in 74.1% cases. The survival of stage IV patients was worse compared to other stages, and the presence of organ metastases markedly impaired the prognosis. We have shown in our study, that radical surgery is still the best therapeutic method for colorectal tumors. Within the surgical technique, the use of a harmonic scalpel has proved beneficial, as it enables a bloodless operative field while ensuring the necessary radicality and preserving the nerve plexuses. Neoadjuvant chemo-radiotherapy is considered a method of choice in rectal tumors surgery; it shows better results than radiotherapy only. Its inclusion into standard protocols has been still hindered by the lacking evidence of effectiveness at the II or I level. The possibility of administering oral fluoropyrimidines makes these studies even more attractive (Fig. 6, Ref. 30).