Loupakis F et al. - As it is no longer possible to define a standard treatment for all patients, we discuss the principles that should guide our decision-making process. In particular, we distinguish five categories of patients: with immediately resectable metastases; with 'marginally' or 'potentially' resectable metastases; with either never resectable widespread aggressive disease or tumour-related performance status deterioration or both; with never resectable widespread indolent disease and without tumour-related performance status deterioration; at high-risk of toxicity either because of comorbidities or age or both. For each group, the intensity of the first-line chemotherapy is discussed, considering recent data from randomized trials.
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