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Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment
Journal of Clinical Oncology, 06/10/09

Poultsides GA et al. - In a study to describe the frequency of interventions necessary to palliate the intact primary tumor in pts who present with synchronous, stage IV colorectal cancer (CRC) and who receive up-front modern combination chemotherapy without prophylactic surgery, it appears that most pts with synchronous, stage IV CRC who receive this treatment never require palliative surgery for their intact primary tumor. These data support use of chemotherapy, without routine prophylactic resection, as the appropriate standard practice for pts with neither obstructed nor hemorrhaging primary colorectal tumors in the setting of metastatic disease.

Methods

By using a prospective institutional database, 233 consecutive pts were identified 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 initial treatment.
Incidence of subsequent use of surgery, radiotherapy, and/or endoluminal stenting to manage primary tumor complications was recorded.

Results

Of 233 pts, 217 (93%) never required surgical palliation of their primary tumor.
16 pts (7%) required emergent surgery for primary tumor obstruction or perforation, 10 pts (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 pts, 47 pts (20%) ultimately underwent elective colon resection at the time of metastasectomy, and 8 pts (3%) underwent 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.