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February 17, 1989

Adjuvant Chemotherapy in Colorectal Cancer: Mournful, Hopeful Perpetual Motion Machine Heads to Dim Light at End of Tunnel

JAMA. 1989;261(7):987. doi:10.1001/jama.1989.03420070037010

To the Editor.—  The meta-analysis of Buyse et al1 and the accompanying editorial2 identify a double standard that discriminates against patients with colorectal cancer. The same order of success that created enthusiasm for the adjuvant therapy of breast cancer has failed to create a similar response for analogous patients with colorectal cancer.The medical community's history of inappropriate responses to promising colorectal cancer trials should cause serious concern. Good controlled trials describing improved survival, based on variants of the now-respectable metaanalysis for adjuvant trials3 and the dose intensity concept for advanced disease, which doubles the frequency of objective tumor regression,4 were incorrectly attacked as invalid and trivial. Controlled trials that found that chemotherapy enhanced radiotherapy were largely ignored for years.5 Combined modality therapy regimens for rectal cancer are still too often disregarded in preference to radiotherapy that has failed consistently in controlled trials and now