Adjuvant Chemotherapy

The idea behind adjuvant treatment is to eliminate any micro-metastatic disease left behind after locoregional treatment. One benefit of administering chemotherapy after surgery or radiation, or both, is that the tumor is addressed with definitive therapy first, unlike neoadjuvant therapy, where it is delayed. Also, as no chemotherapy is given preoperatively, there is no decrease in the patient's nutritional, immunologic, hematologic, or general health status. The disadvantages are that the vascularity has been interrupted, so theoretically less of the drug will get to the residual cancer. Also, these patients have already been disabled by the initial treatment and are unlikely to be compliant with a further decrease in their performance status.

Two trials have shown a significant improvement in survival rates for those who underwent adjuvant therapy.49'68 Unfortunately, these patients also had concomitant chemo- and radiotherapy, so no definite conclusion can be made. Of the many other trials performed using definitive treatment with or without adjuvant chemotherapy, no survival benefit has been seen.40,75,76 Distant metastases have been seen to decrease in some trials, but this has not had an impact on overall survival. Finally, the Head and Neck Contracts Program trial exemplifies the difficulties in getting patients to be compliant: only 9% of the 151 patients scheduled to receive adjuvant therapy completed all six courses.40

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