Adjuvant treatment for colorectal cancer

Colorectal cancer is a leading cause of cancer in Western countries. Surger y remains the only way to cure it. Recent trials led to the general accepta nce of adjuvant chemotherapy in Dukes C cancer by identifying bolus 5FU and leucovin during 6 months (5 days monthly) as the current standard. The rol e of adjuvant chemotherapy remains questionable in Dukes B2 (stage II) colo n cancer, in rectal cancer and after curative resection of liver metastases . The development of total mesorectum excision (TME) technique has dramatical ly resulted in improving local recurrence control and will be the standard in rectal cancer surgery; preoperative irradiation is widely used in Europe for stage II and III rectal cancer but its definite place and its optimal regimen await further assessment as well as the role of adjuvant chemothera py in rectal cancer. New chemotherapeutic combinations based on new effective agents in colorect al cancer such as CPT-11 and oxaliplatine have been currently used for down staging liver metastases initially unresectable. This new approach, combine d with the development of local ablative therapies such as cryotherapy and radiofrequency allows curative strategies in a significant number of patien ts primarily unfit for surgical resection of liver mets. The present paper aims to review the different aspect of (neo)adjuvant ther apies in the multimodal curative management of colorectal cancers.