Adjuvant chemotherapy and cancer cure

The use of chemotherapy as an adjuvant to surgery and/or radiotherapy is well founded in experimental tumor system, and appears to be effective in patients in some circumstances. It is clear from both clinical and experimental studies that (1) the dose is important, (2) the earlier chemotherapy is started after primary therapy the better, and (3) combination chemotherapy may be more effective than single agent treatment. The better the risk of recurrence can be estimated, the better the risk-benefit ratio using adjuvant therapy can be assessed. Not only is the relative risk of recurrence to be considered in the decision as to what patients are to be treated, but also the success of "salvage" therapy. Finally, some evidence is presented to indicate that alkylating agents may not be necessary in combination regimens for adjuvant therapy if effective antimetabolite combinations are available.