Initial Presentation With Stage IV Colorectal Cancer

Rosen, Seth; Buell, Joseph F.; Yoshida, Atsushi; Kazsuba, S; Hurst, Roger D.; Michelassi, Fabrizio; Millis, J. Michael; Posner, Mitchell C.

doi:10.1001/archsurg.135.5.530

Cited by 241 publications

(178 citation statements)

References 11 publications

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“…Our frequency of 78% undergoing resection was lower than that in US studies (90 -92%; Ciccolallo et al, 2005) but close to figures for European community practice (Gatta et al, 2000;Pitchforth et al, 2002). The differences may be partly a result of variations in stage distribution between populations, but are more likely to be due to lack of consensus regarding resection of the primary tumour in stage IV patients (Rosen et al, 2000;Sarela et al, 2001;Ruo et al, 2003). In two US population-based studies, 66% of stage IV patients of all ages (Cook et al, 2005) and 72% of those aged X65 had primary cancerdirected surgery (Temple et al, 2004); this was 51% in our study overall.…”

Section: Treatment Rates and Trends Over Timecontrasting

confidence: 49%

Inequity in colorectal cancer treatment and outcomes: a population-based study

et al. 2008

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Several uncertainties surround optimal management of colorectal cancer. We investigated treatment patterns and factors influencing treatment receipt and mortality in routine clinical practice. We included 15 249 individuals, recorded by the National Cancer Registry (Ireland), with primary invasive colon or rectal tumours, diagnosed during 1994 -2002. Logistic regression and Cox proportional hazards were used to determine factors associated with treatment receipt within 1 year of diagnosis and with mortality, respectively. A total of 78% had colorectal resection, 31% chemotherapy, and 13% radiotherapy (4% colon; 28% rectum). Half of stage IV patients underwent resection. Chemotherapy and radiotherapy use increased by at least 10% per annum. There was a notable increase in pre-operative radiotherapy from 2000 onwards. Patient-related factors were significantly associated with treatment receipt. Patients who were male, older, not married, or smokers had significantly higher risks of death. Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer. For rectal cancer, pre-operative radiotherapy was associated with reduced mortality. Surgery and chemotherapy were associated with longer survival for stage IV patients. The observed inequities in treatment and outcomes suggest that there is potential for further dissemination of therapies in routine practice. Improving treatment availability overall, and equity, has the potential to reduce mortality.

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Section: Treatment Rates and Trends Over Timecontrasting

confidence: 49%

Inequity in colorectal cancer treatment and outcomes: a population-based study

et al. 2008

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Section: Original Articlementioning

confidence: 99%

“…Outcomes in such patients are defined by the extent of hepatic tumor burden (3,11). Although aggressive primary tumor characteristics portend a high risk for distant metastases (10,11), the correlation between primary tumor biology and the extent of intrahepatic metastatic disease requires further clarification. The biologic significance of nodal staging in patients with liver metastases (LM) may become increasingly important as patients with synchronous disease are more likely to obtain control of their liver disease with more effective systemic regimens and potentially immunotherapy (12).…”

Section: Original Articlementioning

confidence: 99%

Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer

Ahmad¹,

Reha²,

Saied³

et al. 2017

Hepatobiliary Surg. Nutr.

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“…There is no doubt that resection or stoma placement is mandatory before starting systemic chemotherapy among patients with severe intestinal symptoms 1, 2, 3. Palliative resection of primary tumors reportedly improves systemic chemotherapy efficacy4 and prolongs time to treatment failure 5.…”

Section: Introductionmentioning

confidence: 99%

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

Yoshida

Aisu

Kojima

et al. 2017

Annals of Gastroent Surgery

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Initiating chemotherapy usually requires a delay of more than 4 weeks after surgically resecting colorectal cancer. However, there is little evidence regarding the required delay interval. We have previously reported a pilot study to determine the safety and feasibility of early initiation of chemotherapy after resecting primary colorectal cancer with distant metastases. We aimed to determine the safety and efficacy of early initiation of chemotherapy after resecting colorectal cancer with distant metastases.This phase II study (trial number UMIN000006310) was a prospective, single‐arm trial. A total of 20 patients (men, 15 and women, 5) were enrolled. They underwent XELOX therapy (130 mg/m2 oxaliplatin on day 1+1000 mg/m2 capecitabine twice daily on days 1‐4) on postoperative day 7 and XELOX+bevacizumab (7.5 mg/kg bevacizumab on day 1) after the second chemotherapy cycle.Baseline characteristics included a median age of 64 (range, 43‐72) years. Surgical procedures included right hemicolectomy in six patients, sigmoidectomy in three, anterior resection in five, and Hartmann procedure in six. All patients started chemotherapy on postoperative day 7. Median progression‐free survival was 14.9 months; overall response rate was 80%. Disease control rate was 100%. Grade 3 or higher hemotoxicity and grade 3 or higher non‐hematological toxicity was noted in 5.0% and 25.0% of patients, respectively. Postoperative complications were observed in two patients (superficial incisional surgical site infection and ileus).Early initiation of chemotherapy after surgery is feasible. These findings suggest future changes of the start time of chemotherapy after surgery.

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Initial Presentation With Stage IV Colorectal Cancer

Cited by 241 publications

References 11 publications

Inequity in colorectal cancer treatment and outcomes: a population-based study

Inequity in colorectal cancer treatment and outcomes: a population-based study

Association of primary tumor lymph node ratio with burden of liver metastases and survival in stage IV colorectal cancer

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

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