Adjuvant therapy of colorectal cancer: the next step forward

Adjuvant therapy for colorectal cancer includes chemotherapy, radiotherapy and immunotherapy. It is advocated in patients who are at significant risk of developing recurrence. We review recent advances in adjuvant treatment for colorectal cancer. Although colorectal cancer is often considered as a single entity, it is being increasingly recognised that colon and rectal cancers are distinct disease groups and separate therapeutic strategies should be considered for each. In colonic cancer, 5-fluorouracil is used, with or without other agents. Both preoperative radiotherapy and postoperative chemoradiotherapy have been used in rectal cancer. The development of oral chemotherapeutic agents has been a significant step in the management of colorectal cancer, while newer agents have been introduced with good results. Targeting the immune response and genetic manipulations are being developed as innovative management strategies. Although adjuvant therapy has improved outcome in colorectal cancer, stress should be laid on identifying patients who need adjuvant therapy, permitting individualisation of treatment strategy. Apart from including survival and local recurrence as outcome measures, new therapeutic approaches should be assessed in terms of quality of life of the patient.