Comparison of the Eight-Hour With the 22-Hour Infusion of 5-Fluorouracil, in the FOLFOX Chemotherapy of Colon Cancer: A Retrospective Study

Abstract

Background: The optimal protocol for administration of 5-fluorouracil (5-FU) in chemotherapy of colorectal cancer is unknown. Objectives: We compared treatment outcomes of short-time infusion of 5-FU (8-hour infusion) with 22-hour infusion, in chemotherapy management of colorectal cancer. Patients and Methods: A retrospective study was conducted on colon cancer patients, who have been treated for at least 24 weeks with the FOLFOX regimen (5-FU, leucovorin, and oxaliplatin). Patients who had received infusion of 5-FU, either over 8 hours (5-FU 8h) or over 22 hours (5-FU 22h) were selected. The study endpoints were 3 and 5 years disease free survival and overall survival. Results: A total of 58 patients, in the 5-FU 8h, and 50 patients, in the 5-FU 22h groups, were studied. Based on the intention-to-treat analysis, there was a lower overall mortality (44% vs. 22.4%, P = 0.023) and lower overall relapse (46% vs. 18.9%, P = 0.004), as well as a higher 3 years disease free survival (81% vs. 58%, P = 0.011) in the 5-FU 8h, compared with 5-FU 22h group. The Log Rank test showed a difference between the two groups, for disease free survival (P = 0.008), as well as overall survival (P = 0.014), confirmed by Cox Regression analysis: hazard ratio [95% CI] = 0.365 [0.160 to 0.833] and 0.286 [0.100 to 0.817], respectively. Conclusions: We found better outcomes for the colon cancer patients, who had received infusion of 5-FU 8h, compared with 5-FU 22h, in the FOLFOX chemotherapy. These findings should be tested in prospective clinical trials.