Consensus conference on medical treatment of XXXX : adjuvant treatment.

@entity1 @entity6307 @entity1149 @entity900 @entity204
The 5-year survival rate for @entity1 with @entity1149 ( @entity1149 ) who undergo complete surgical resection is only 40-69%, depending on the stage. It is well known that distant metastatic disease is the dominant site of recurrence in such @entity1 and this observation served as the basis for trials of postoperative systemic therapy. The earliest trials of adjuvant chemotherapy, which consisted of single alkylating agents, did not achieve this goal or, even worse, showed a detrimental effect on survival. The introduction of more active drugs, such as @entity900 and vinca alkaloids, made it possible to obtain more promising results in terms of delayed recurrence of the disease. A recent meta-analysis of all randomized trials with accrual from January 1965 to December 1991 showed that the absolute risk of @entity204 was reduced by 3% at 2 years and by 5% at 5 years for @entity1 who were treated with postoperative @entity900 -containing regimens compared with @entity1 who were treated with surgery alone. Although the results of this meta-analysis suggest that postoperative @entity900 chemotherapy regimens may result in a slight survival improvement, adjuvant chemotherapy in @entity1149 cannot be considered a standard therapy, and it is important that large, carefully conducted, randomized trials are performed in this group of @entity1 . Four such randomized trials are being conducted in Europe. One of them, the @entity6307 trial, recently completed its accrual with 1200 @entity1 . The IALT, ANITA, and MRC trials are still ongoing. The results of such trials are eagerly awaited and it is hoped that, once the value of postoperative chemotherapy is well ascertained, future developments can further improve results of combined treatment. In such direction, the recently reported results of PORT meta-analysis evaluating the role of radiation therapy are of great contribution in selecting a suitable population for future studies. In fact, only @entity1 with pN2 disease seem to have a beneficial effect in terms of survival, especially if they have a good performance status, while radiotherapy is not justified in N0-1 @entity1 . The optimal integration of chemotherapy and radiation therapy when both therapies are indicated represents another goal for future research.
