No more room for nihilism

It is now over five years since the publication of two randomised trials showing that fluorouracil and levamisole reduced the relapse rate by 40% and mortality by a third in patients with node positive colorectal cancer.1 2 The final report of these data was recently published, showing 168 deaths in control patients versus only 121 in patients who received adjuvant treatment (P<0.005).3 Despite these data, a recent survey of oncologists and surgeons in Britain showed that most oncologists offered adjuvant chemotherapy to appropriate patients while many surgeons remained sceptical (R Grey, personal communication).

The combination of fluorouracil and folinic acid has proved superior to fluorouracil alone in patients with advanced colorectal cancer.4 The Canadian and Eurpean consortium trial (IMPACT) compared adjuvant treatment with high dose fluorouracil and folinic acid with no treatment in nearly 1500 patients; it showed a 22% reduction in mortality, predominantly in patients with Dukes's type C colon cancer.5 A similar but much smaller Italian study showed a 39% …