A perspective on clinical research strategies in carcinoma of the large bowel.

Experience with screening for colorectal cancer has been disappointing. Prevention of this disease seems to be a more beneficial research direction. Although radical surgery presents the best treatment option, it is nonetheless an inadequate strategy by itself. A new dose intensive approach would temporally combine surgery and chemotherapy as a coordinated event. This would allow maximal cytoreduction over a minimal time period and little or no development of resistant cancer cells. This approach has resulted in a 75% projected 5 year survival in patients with peritoneal carcinomatosis from cystadenocarcinoma. Strategies for application of this cytoreductive approach in many patients with advanced gastrointestinal cancer are present.