The Need for Further Adjuvant Trials in Gastrointestinal Cancer

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Abstract
With a few notable exceptions, surgical adjuvant therapy has little altered the survival of patients with gastrointestinal cancers. Progress has resulted from earlier diagosis due to fiberoptic endoscopy, and to improvements in surgical technique. Large trials including thousands of patients offer statistically reliable outcomes. Smaller, well-designed, carefully analyzed phase II trials may identify significant treatment advances worthy of further study. A treatment advance of unquestioned benefit resulting largely from a phase II study revolutionized the treatment of anal canal cancer and eliminated the inevitability of colostomy. Trials in esophageal cancer suggest significant benefit from a variety of neoadjuvant approaches which may eventually supplant surgical intervention. Adjuvant combined therapy of rectal cancer has improved patient survival and the quality of life, as have phase III chemotherapy trials in colon cancer. Smaller studies in pancreatic cancer have suggested a benefit of radiation and chemotherapy following resection but 80% still die within three to five years. As yet, no effective therapy has been identified for patients with many other gastrointestinal cancers while there are significant numbers of patients for whom new and effective surgical adjuvant therapies would be beneficial, more than half of all current patients with gastrointestinal cancers still die as a result of their diseases. Ample opportunities for further well-designed prospective trials exist.

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