Is there a role for adjuvant therapy in bowel cancer?

Most patients operated on for large bowel cancer who undergo potentially curative resection will benefit from adjuvant therapy. In colon cancer, the current standard therapy is chemotherapy with 5-fluorouracil (5-FU) and levamisole given for 1 year to patients with resectable, node-positive disease. Current clinical trials may define better regimens, as well as the role of adjuvant therapy for some patients with node-negative colon cancer. Patients with resectable rectal cancer, both those who are node positive and those with tumor extending to the serosa (Dukes' B2) are appropriately treated with a combination of postoperative radiation therapy and chemotherapy, the latter given for 6 months. 5-FU alone is currently the preferred chemotherapy regimen from clinical trial data, unless current studies define a more optimal regimen. Preoperative radiotherapy, antitumor vaccines, and intraportal vein therapy have not yet become standard therapy. Resection alone is no longer sufficient for most patients with large bowel cancer. Responsible physicians should see that such patients are considered for adjuvant therapy, or preferably, entered into ongoing controlled clinical trials designed to make current adjuvant therapy better.