[Acceptable risks in adjuvant therapy]

The definition of acceptable risks in adjuvant therapies has to be based on the evaluation of the cost-benefit relationship. The possible benefit can only be determined by prospective clinical trials for each tumor category. Individually, the possible benefit cannot be weighed as long as no method for the detection of micrometastases is available. Statistically, successful or promising adjuvant treatments, treatments in the experimental phase, treatments with controversial or with clearly negative results can be defined for the various malignant tumors. The risks consist in short-, medium- and long-term side-effects of adjuvant therapies, especially of adjuvant chemotherapy. Of special importance for the cost-benefit evaluation are long-term organ toxicities and the induction of second neoplastic diseases. The definition of acceptable risks involves not only medical, but also ethical considerations. But all these considerations should be based as far as possible on objective facts and not on prejudice.