[Adjuvant chemotherapy in cancers of the gastrointestinal tract (GIT)]

A critical review of adjuvant therapies of gastrointestinal tumors shows that this is a field of active clinical investigation. Unfortunately the results that have been achieved until now have not fulfilled the expectations. Neoadjuvant therapies of squamous cell carcinomas of the esophagus and the anus in many cases lead to pathologically documented complete remissions. After a 10 years follow-up, it is evident that for anal carcinoma such pathological complete remissions translate into longterm remissions and eventually cures. The same conclusion, however, can not yet be drawn for esophageal cancer. The role of adjuvant chemotherapy in gastric carcinoma remains unclear. The results of the current FAM-studies are eagerly awaited. In pancreatic cancer the combination of radiotherapy and 5-FU may probably prolong disease-free survival and survival for a limited time period. Many adjuvant studies have been done in colonic cancer, without any conclusive data regarding the role of chemotherapy. Some indications point to biological response modifiers, immuno- and regional therapies to be effective in the adjuvant situation. The results of adjuvant chemotherapy in rectal cancer after radiotherapy or radiochemotherapy are easier to judge. They show that some patients profit from adjuvant therapy. But the most efficient combinations and the role of newer modalities remain to be elucidated (Fig. 8 a-8c).