A Cochrane review [Abstract] 1 included 13 studies with a total of 1 365 subjects with advanced or metastasized colorectal cancer assessing the effect of palliative chemotherapy on progression free and overall survival. In 9 studies 5-fluorouracil alone or in combination with other agents was used. Other trials evaluated the use of floxuridine (2), irinotecan (1) and tauromustine (1). Meta-analyses were performed using both published data and individual patient data (63%). Chemotherapy was associated with significant improvement in survival at 12 months (RR 0.79; 95% CI 0.72 to 0.89) compared to best supportive care for published data. The reduction for risk of death in individual patient meta-analyses was 35% (HR 0.65; 95% CI 0.56 to 0.76). The effectiveness of palliative chemotherapy did not appear to vary across different age bands. Progression-free survival was also significantly longer in the chemotherapy arms; RR 0.64 at 3 months (95% CI 0.54 to 0.76), 0.78 at 6 months (95% CI 0.69 to 0.88) and 0.86 at 12 months (95% CI 0.77 to 0.96). Treatment toxicity and impact upon quality of life and symptom control have been inadequately assessed in the majority of trials.
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