Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment Journal Article

   

Authors:	Poultsides, G. A.; Servais, E. L.; Saltz, L. B.; Patil, S.; Kemeny, N. E.; Guillem, J. G.; Weiser, M.; Temple, L. K. F.; Wong, D. W.; Paty, P. B.
Article Title:	Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment
Abstract:	Purpose: The purpose of this study was to describe the frequency of interventions necessary to palliate the intact primary tumor in patients who present with synchronous, stage IV colorectal cancer (CRC) and who receive up-front modern combination chemotherapy without prophylactic surgery. Patients and Methods: By using a prospective institutional database, we identified 233 consecutive patients from 2000 through 2006 with synchronous metastatic CRC and an unresected primary tumor who received oxaliplatin- or irinotecan-based, triple-drug chemotherapy (infusional fluorouracil, leucovorin, and oxaliplatin; bolus fluorouracil, leucovorin, and irinotecan; or fluorouracil, leucovorin, and irinotecan) with or without bevacizumab as their initial treatment. The incidence of subsequent use of surgery, radiotherapy, and/or endoluminal stenting to manage primary tumor complications was recorded. Results: Of 233 patients, 217 (93%) never required surgical palliation of their primary tumor. Sixteen patients (7%) required emergent surgery for primary tumor obstruction or perforation, 10 patients (4%) required nonoperative intervention (ie, stent or radiotherapy), and 213 (89%) never required any direct symptomatic management for their intact primary tumor. Of those 213 patients, 47 patients (20%) ultimately underwent elective colon resection at the time of metastasectomy, and eight patients (3%) underwent this resection during laparotomy for hepatic artery infusion pump placement. Use of bevacizumab, location of the primary tumor in the rectum, and metastatic disease burden were not associated with increased intervention rate. Conclusion: Most patients with synchronous, stage IV CRC who receive up-front modern combination chemotherapy never require palliative surgery for their intact primary tumor. These data support the use of chemotherapy, without routine prophylactic resection, as the appropriate standard practice for patients with neither obstructed nor hemorrhaging primary colorectal tumors in the setting of metastatic disease. © 2009 by American Society of Clinical Oncology.
Keywords:	survival; adult; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; primary tumor; major clinical study; overall survival; mortality; bevacizumab; fluorouracil; cancer combination chemotherapy; bone metastasis; cancer radiotherapy; cancer staging; outcome assessment; methodology; antineoplastic agent; neoplasm staging; laparotomy; prospective study; colorectal cancer; palliative care; tumor localization; metastasis; cohort studies; statistics; antineoplastic combined chemotherapy protocols; palliative therapy; cohort analysis; pathology; irinotecan; colorectal neoplasms; liver metastasis; lung metastasis; colorectal tumor; folinic acid; brain metastasis; colon resection; stent; external beam radiotherapy; oxaliplatin; factual database; databases, factual; tumor perforation
Journal Title:	Journal of Clinical Oncology
Volume:	27
Issue:	20
ISSN:	0732-183X
Publisher:	American Society of Clinical Oncology
Date Published:	2009-07-10
Start Page:	3379
End Page:	3384
Language:	English
DOI:	10.1200/jco.2008.20.9817
PUBMED:	19487380
PROVIDER:	scopus
PMCID:	PMC3646319
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-70249148634&partnerID=40&md5=9ab5f1279da357c09aef4fe31e8a9069
Notes:	--- - "Cited By (since 1996): 25" - "Export Date: 30 November 2010" - "CODEN: JCOND" - "Source: Scopus"

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