Overcoming the Challenges of Primary Tumor Management in Patients With Metastatic Colorectal Cancer Unresectable for Cure and an Asymptomatic Primary Tumor

Matsumoto, Takuya; Hasegawa, Suguru; Matsumoto, Shigemi; Horimatsu, Takahiro; Okoshi, Kae; Yamada, Masahiro; Kawada, Kenji; Sakai, Yoshiharu

doi:10.1097/dcr.0000000000000025

Cited by 46 publications

(35 citation statements)

References 16 publications

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“…They found that nontraversable lesions had higher 2-year rates of symptomdirected surgery than those with colonoscope-traversable lesions (64.3 vs 9.9 %). Moreover, the median time until symptom-directed surgery was significantly lower in colonoscopic non-traversable tumours (2.1 vs 15.5 months; p=0.01) [17]. Miyamoto et al found that patients with circumferential tumours were likely to suffer an obstruction during chemotherapy treatment [18].…”

Section: Discussionmentioning

confidence: 99%

Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection

Suárez

Marín

Vera

et al. 2015

Int J Colorectal Dis

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Section: Discussionmentioning

confidence: 99%

Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection

Suárez

Marín

Vera

et al. 2015

Int J Colorectal Dis

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“…Initialement compris entre 9 et 30 %, ces taux provenaient d'études comprenant des patients traités avec d'anciens protocoles de chimiothérapie [6][7][8][11][12][13][14][15][16]. Dans les études plus récentes dans lesquelles les patients étaient traités par des chimiothérapies efficaces (oxaliplatine, irinotécan, biothérapies), ce risque était moindre, compris entre 11 et 22 % [9,10,[17][18][19][20]. Ces résul-tats pourraient s'expliquer par le fait que les chimiothé-rapies de nouvelle génération ont également une importante efficacité antitumorale sur la TP et permettent un meilleur contrôle local en cas de tumeur laissée in situ [21].…”

Section: Taux De Complications Liées à La Tp Au Cours D'une Chimiothéunclassified

“…Dans la littérature, 17 études rétrospectives et deux études de cohorte ont évalué l'impact de la colectomie première sur la survie de patients avec un CCR métastatique avec méta-stases synchrones non résécables, avec un total de 5 555 patients (Tableau 3) [6][7][8][9]11,[13][14][15][18][19][20]23,26,[34][35][36][37][38][39]. Douze études concluaient à une augmentation significative de la SG lorsque la prise en charge débutait par la résec-tion de la TP [7][8][9]13,23,26,[34][35][36][37][38][39].…”

Section: Impact De La Résection De La Tp Sur La Survie Chez Les Patieunclassified

“…Afin de surmonter ces biais, certaines études rétrospecti-ves récentes ont réalisé une analyse multivariée en utilisant un score de propension [9,19,20,24,38,39]. Ainsi, dans une étude française incluant 208 patients, la médiane de SG était presque neuf mois plus longue dans le groupe des patients ayant eu une résection première (30,7 vs 21,9 mois ; HR = 0,56 ; p = 0,031) [9].…”

Section: Impact De La Résection De La Tp Sur La Survie Chez Les Patieunclassified

“…À l'inverse, dans l'étude de Matsumoto et al [19], cette différence n'était pas significative (HR = 0,72 ; IC 95 % : 0,42-1,25). De la même manière, dans l'étude de Yun et al [20], le taux de SG à cinq ans était plus important dans le groupe « résection » que dans le groupe « chimiothérapie d'emblée » en prenant l'ensemble de la cohorte (7,9 vs 3,0 %, p < 0,0001), mais la différence n'était plus significative après appariement des patients (4,9 vs 3,5 %, p = 0,27).…”

Section: Auteursunclassified

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Unresectable metastases: what about the primary tumour?

2014

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Au moment du diagnostic, 25 % des patients avec un cancer colique ont des métastases hépatiques synchrones. La majorité d'entre elles sont jugées non résécables, néces-sitant alors une prise en charge palliative. Chez ces patients, la stratégie thérapeutique à adopter (résection de la tumeur primitive [TP] suivie d'une chimiothérapie ou chimiothé-rapie d'emblée avec TP laissée en place) reste à ce jour largement débattue. Aucune étude randomisée ne permet de répondre à cette question. Les objectifs de cette revue étaient de réaliser une analyse critique quant à l'intérêt de la résec-tion de la TP chez un patient porteur d'un cancer colique métastatique avec des métastases hépatiques synchrones non résécables lorsque la tumeur colique est a-ou paucisymptomatique. Mots clés Cancer du côlon · Métastases hépatiques · Traitement palliatif · Chirurgie colique · ChimiothérapieAbstract At the time of diagnosis, 25% of patients with colorectal cancer present with synchronous liver metastases. The majority of these metastases are considered unresectable, thus requiring palliative care. Whether primary tumour resection followed by chemotherapy or immediate chemotherapy without primary tumour resection is the best therapeutic option in these patients is still debated. No prospective randomized study is available to clarify this issue. The objective of this review was to carry out a critical analysis about the importance of primary tumour resection in patients with asymptomatic or pauci-symptomatic colon cancer and unresectable synchronous liver metastases.

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Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment

et al. 2021

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The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR.OBJECTIVE To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality.DESIGN, SETTING, AND PARTICIPANTS CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible.INTERVENTIONS Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab. MAIN OUTCOMES AND MEASURESThe aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol.RESULTS A total of 196 patients were included in the intention-to-treat analysis (112 [57%] men; median [IQR] age, 65 [59-70] years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics.CONCLUSIONS AND RELEVANCE Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited.

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Overcoming the Challenges of Primary Tumor Management in Patients With Metastatic Colorectal Cancer Unresectable for Cure and an Asymptomatic Primary Tumor

Abstract: Approximately 75% of upfront chemotherapy patients with unresectable, asymptomatic stage IV colorectal cancer can be spared initial resection of the primary tumor. Colonoscopic findings of nontraversable lesions at diagnosis may predict the need for late surgical intervention.

Cited by 46 publications

References 16 publications

Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection

Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection

Unresectable metastases: what about the primary tumour?

Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment

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