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In this situation, chemotherapy is used because, statistically, patients receiving chemotherapy have a better chance of survival than patients without chemotherapy. However, this does not apply as a general rule since, for one given patient, the side effects of chemotherapy may annihilate its statistical positive effect.

Explanatory diagram of the aim of chemotherapy with an adjuvant intent

Thus, in this setting, it is not legitimate to take unreasonably high risks, in particular numerous and potentially lethal aplasia episodes or prolonged hospitalisations.

Adjuvant chemotherapy

It is prescribed after the main treatment modality.

With the addition of chemotherapy, the results of this major treatment (surgery or radiotherapy) are statistically improved.

What does the above diagram mean? 50% of patients are cured by the initial treatment, with or without chemotherapy. 40% cannot be cured by the initial treatment PLUS chemotherapy. Thus, the genuine benefit of adjuvant chemotherapy concerns only 10% of patients.

This small number explains current research on prognostic factors, proteomics and other characteristics which might determine the patients for whom chemotherapy is not necessary (the 50%) or for whom more intensive treatment might be justified due to the poor results obtained with standard treatment (the unfortunate 40%). Unfortunately, we are, as yet, unable to differentiate the various categories and must deliver adjuvant chemotherapy to all patients.

In this category of adjuvant chemotherapy, we can name:

• breast cancer,

• colo-rectal cancer,

• bladder cancer,

• head and neck cancer,(?)

• cervix cancer(?).
  

Neoadjuvant chemotherapy

The aim of neoadjuvant chemotherapy is to reduce the size of the primitive tumour thus making it easier to operate. If chemotherapy is not efficient, the patient will require more extensive surgery.

For instance:

• Neoadjuvant chemotherapy of a very extensive breast carcinoma may change the necessary surgery from mastectomy to lumpectomy

• Neoadjuvant chemotherapy of urinary bladder cancer may, in association with radiotherapy, enable continued bladder retention.

For some authors, the results of neoadjuvant chemotherapy are not convincing enough to avoid radical surgery.