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April 18, 1977

Adjuvant Chemotherapy: Correct Advice?

JAMA. 1977;237(16):1691. doi:10.1001/jama.1977.03270430033006

To the Editor.—  We take exception to suggestions made by Dr Turnbull for adjuvant chemotherapy in a case of Dukes stage C colonic cancer (237:385, 1977).Dr Turnbull correctly states that the adjuvant use of fluorouracil and semustine (methyl-CCNU) is investigational with insufficient long-term experience, and yet he goes on to recommend adjuvant therapy.Published results of adjuvant chemotherapy for colon cancer deal primarily with the use of thiotepa,3,4 intravenous fluorouracil,5 intraluminal fluorouracil,6 and intravenous floxuridine.7In evaluating results of adjuvant therapy in this disease, one must realize that improved surgical techniques have led to better five-year survival rates for all patients with operable colonic cancers. Current figures for survival following surgery alone range from 50% to 55% in several large series.1,2Holden and co-workers3 reported the results of a university hospital cooperative study involving 693 patients, half of whom were treated with adjuvant