The second option is worth considering for patients with large or multiple liver lesions because this route results in delivery of a higher dose of chemotherapy to the liver metastases. The underlying principle is that liver metastases derive their blood supply primarily through the hepatic arterial circulation, whereas normal liver derives most of its blood supply through the portal vein. The major adverse effect of intraarterial FUDR is sclerosing cholangitis, which may be quite severe and may necessitate discontinuation of therapy.

Studies have demonstrated a survival advantage for patients with Dukes stage C. colon cancer who receive adjuvant chemotherapy. The 5-FU-based therapy has been administered in the past according to several schedules, including continuous infusion daily for 5 days every 4 weeks (Mayo Clinic regimen) and weekly for 6 weeks with 2 weeks off (Roswell Park regimen).

In terms of patient survival, no study has demonstrated the superiority of daily...
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