Unresectable Synchronous Metastases Research Articles

Primary Tumor Resection Before Systemic Therapy in Patients With Colon Cancer and Unresectable Metastases: Combined Results of the SYNCHRONOUS and CCRe-IV Trials.

Chemotherapy is established as primary treatment in patients with stage IV colorectal cancer and unresectable metastases. Data from nonrandomized clinical trials have fueled persistent uncertainty if primary tumor resection (PTR) before chemotherapy prolongs survival. We investigated the prognostic value of PTR in patients with newly diagnosed stage IV colon cancer who were not amenable to curative treatment. Patients enrolled in the multicenter, randomized SYNCHRONOUS and CCRe-IV trials were included in the analysis. Patients with colon cancer with synchronous unresectable metastases were randomly assigned at 100 sites in Austria, Germany, and Spain to undergo PTR or up-front chemotherapy (No PTR group). The chemotherapy regimen was left at discretion of the local team. Patients with tumor-related symptoms, inability to tolerate surgery and/or systemic chemotherapy, and history of another cancer were excluded. The primary end point was overall survival (OS), and the analyses were performed with intention-to-treat. A total of 393 patients were randomly assigned to undergo PTR (n = 187) or no PTR (n = 206) between November 2011 and March 2017. Chemotherapy was not administered to 6.4% in the No PTR group and 24.1% in the PTR group. The median follow-up time was 36.7 months (95% CI, 36.6 to 37.3). The median OS was 16.7 months (95% CI, 13.2 to 19.2) in the PTR group and 18.6 months (95% CI, 16.2 to 22.3) in the No PTR group (P = .191). Comparable OS between the study groups was further confirmed on multivariate analysis (hazard ratio, 0.944 [95% CI, 0.738 to 1.209], P = .65) and across all subgroups. Patients with serious adverse events were more common in the No PTR group (10.2% v 18.0%; P = .027). Among patients with colon cancer and synchronous unresectable metastases, PTR before systemic chemotherapy was not associated with prolonged OS.

The impact of palliative primary tumor resection on overall survival in minimally symptomatic (asymptomatic) colorectal cancer and synchronous unresectable metastases vs chemotherapy only: a comparative study of outcomes

Aim: to evaluate the impact of primary tumor resection (PTR) on treatment outcomes in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.Patients and Methods: treatment outcomes of patients with minimally symptomatic CRC and synchronous unresectable metastases were retrospectively assessed (2016–2022). Patients with PTR followed by chemotherapy were compared to patients receiving chemotherapy only. Survival was determined by the Kaplan-Meier method and differences were evaluated using the log-rank test and Cox proportional-hazards regression model. To reduce potential selection bias between two groups a propensity score matching (PSM) was performed.Results: no significant differences in 30-day mortality rate (р = 1,00) and the rate of surgical intervention due to complications of first treatment (р = 1,00) between the two groups. Before matching the median survivals were 27,8 and 24 months in the PTR and chemotherapy groups, respectively (р = 0,2). After PSM the overall survival rate at 3 years was 42,1% for the PTR group and 34% for the chemotherapy group (р = 0,47). The median survivals were 27,9 and 24,4 months, respectively. Three-year overall survival rate for patients with stage IVB was significantly higher in the PTR group than in the chemotherapy group (37,8% versus 4,8%; р = 0,02). The median survivals were 36,1 and 17,2 months, respectively. In multivariate analysis radical resection (R0) if unresectable metastases converted into resectable after initial treatment was the only significant prognostic factor for survival (p < 0,001).Conclusions: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases is associated with acceptable postoperative morbidity and mortality rates and may improve overall survival for patients with stage IVB comparing to chemotherapy as a treatment of first line. However, randomized controlled trials are needed.

Palliative primary tumor resection in minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases: when is it necessary? (systematic review)

AIM: to determine if there is an improvement in overall survival of palliative primary tumor resection (PTR) followed by chemotherapy in minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases compared to those of upfront chemotherapy/radiotherapy (chemo/RT) alone.MATERIALS AND METHODS: a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were done on PubMed and Cochrane database.RESULTS: eighteen non-randomized studies were identified, including a total of 2995 patients (1734 PTR and 1261 chemo/RT). Age, gender, American Society of Anesthesiologists (ASA) staging of patients in the two groups were comparable in 12 studies and had significant differences in 4 studies. Median survival in the two groups was comparable in 13 studies (1460 patients: 787 PTR и 673 chemo/RT) and was significantly higher in PTR group in 5 studies (1535 patients: 947 PTR и588 chemo/RT). The rate of surgical intervention due to complications was 0-5.1% in PTR group and 4.4-48.1% in chemo/RT group in 17 studies. Thirty-day mortality was 0-4.8% in PTR group and 0-14% in chemo/RT group in 17 studies. One study had a high 30-day mortality rate in both groups (29.4% PTR и 19.3% chemo/RT, P < 0.05).CONCLUSIONS: the question remains whether palliative primary tumor resection could improve overall survival of minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases. However, the recent data showed that patients who underwent PTR could gain a cancer-specific survival benefit. This conclusion based on the results of nonrandomized comparative studies and data from early terminated RCTs. Further well-designed RCTs are required to reach definitive conclusions.

Randomized clinical trial on resection of the primary tumor versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases.

LBA3507 Background: Systemic chemotherapy improves survival of patients with stage IV colon cancer who are no candidates for curative therapy. However, it has remained controversial, if primary tumor resection prior to chemotherapy further prolongs survival of these patients. We report the combined results of the SYNCHRONOUS and CCRe-IV trial, comparing primary tumor resection followed by systemic chemotherapy to systemic chemotherapy alone in stage IV colon cancer patients. Methods: The SYNCHRONOUS trial (ISRCTN30964555) is a multicentre, randomized, controlled, superiority trial with a two-group parallel design. Colon cancer patients with synchronous unresectable metastases were eligible for inclusion. Exclusion criteria were primary tumor-related symptoms, inability to tolerate surgery and/or systemic chemotherapy and history of another primary cancer. Resection of the primary tumor as well as systemic chemotherapy was provided according to the standards of the participating institution. The primary endpoint was overall survival (OS) with a minimum follow-up of 36 months (ITT population). An interim analysis yielded a pooled median survival time of 18 months. Assuming a difference of 6 months in median survival (15 vs. 21 months) with a two-sided type I error of 5%, power of 80% and an additional recruitment of 15% the total sample size amounted to n=392 patients (n=196 per arm). In order to accelerate reporting of the primary endpoint, data were pooled with the Spanish CCRe-IV trial (NCT02015923) with similar eligibility criteria, interventions and endpoints. Results: Between September 2011 and March 2013, 393 patients were randomized to primary tumor resection before chemotherapy (PTR; n=187) or chemotherapy alone (CTX; n=206) at 100 centers. The final study cohort included n=295 (75.1%) patients from the SYNCHRONOUS trial and n=98 (24.9%) patients from the CCRe-IV trial. The median follow-up was 36.7 months (95% CI: 36.6-37.3). Median OS was 16.7 months (95% CI: 13.2-19.2) in the PTR arm and 18.6 months (95% CI: 16.2-22.3) in the CTX arm. On final analysis, there was no significant difference for OS (HR 0.95, 95% CI: 0.743-1.215; p-value: 0.685), based on a proportional hazard model (shaired frailty). A total of 45 (24.1%) and 13 (6.4%) patients did not receive any chemotherapy in the PTR and CTX arm, respectively. In line with these data, the number of serious adverse events (excluding postoperative complications) was not different in the CTX arm (44; 20.7%) compared with the PTR arm (24; 12.5%). Conclusions: Resection of the primary tumor before chemotherapy does not prolong OS in patients with newly diagnozed, stage IV colon cancer and synchronous unresectable metastases. Clinical trial information: ISRCTN30964555.

Induction Chemotherapy Followed by Primary Tumor Resection Did Not Bring Survival Benefits in Colon Cancer Patients With Asymptomatic Primary Lesion and Synchronous Unresectable Metastases.

BackgroundIt is still controversial whether primary tumor resection (PTR) improves survival in colorectal cancer (CRC) patients with unresectable metastases.MethodsColon cancer patients were enrolled and randomly allocated to with or without PTR after induction chemotherapy with XELOX or mFOLFOX6, and those with chemotherapy failure were excluded. The primary endpoint was TTF (time to strategy failure) on an intent-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT02291744.ResultsBetween April 2015 and July 2020, 140 patients were enrolled, and 54 patients were excluded due to colon obstruction (16), perforation (1), disease progression (22), death (1), radical resection (3), or other reasons (11). After induction chemotherapy, 86 patients were randomized into group A (the resection group, n = 42) or group B (chemotherapy-alone group, n = 44). The median TTF was 143 days (95% CI: 104.9–181.1) in group A and 196 days (95% CI: 96.5–295.5) in group B (HR: 0.930 95% CI: 0.589–1.468, p = 0.755), and there was no significant difference in PFS, OS, and incidence of chemotherapy-related adverse events between two groups. The primary lesion-related events after PTR in group A were significantly fewer than those in group B. Patients with a tumor regression grade (TRG) score of 2 had longer TTF and PFS than those with score of 3.ConclusionPTR after induction chemotherapy could not bring survival benefits for colon cancer patients with unresectable metastases, and it is not recommended routinely. However, it also requires individualized treatment as colon obstruction or perforation occurred in some patients and PTR could reduce primary tumor-related events, and the TRG score might help for selection of beneficial patients.

Impact of Upfront Chemotherapy on the Effect of Primary Tumour Resection for Asymptomatic Synchronous Colorectal Cancer With Unresectable Metastases: A Propensity-Score-Matched Cohort Analysis.

Background:It is controversial whether primary tumour resection (PTR) and the sequencing of chemotherapy and PTR are associated with the survival of patients with incurable stage IV colorectal cancer. This study aimed to explore the effects of PTR and the sequencing of chemotherapy and PTR on asymptomatic colorectal cancer with synchronous unresectable metastases (asmCRC).Patients and Methods:Patients with asmCRC were retrospectively identified from a single centre and categorised into 3 groups: PTR followed by chemotherapy (POC), upfront chemotherapy followed by PTR (UFC), and palliative chemotherapy (PC). The primary end points included median overall survival (OS) and progression-free survival (PFS). Clinical features were analysed using χ2 test, while survival curves were generated using the Kaplan-Meier test. Propensity-score matching (PSM) was performed when comparing survival between POC and UFC groups.Results:From 2008 to 2014, 255 patients were identified and included into the POC (n = 101), UFC (n = 40), and PC (n = 114) groups. The UFC and POC groups had significantly better median OS compared with the PC group (40.7 vs 16.3 months, P < .0001; 39.7 vs 16.3 months, P < .0001). Before PSM, the UFC group had better median PFS than the POC and PC groups (18.5 vs 9.7 months, P = .038; 18.5 vs 6.1 months, P < .0001). After PSM, UFC has better PFS than POC (P = .038). And the UFC group did not have higher postoperative or preoperative morbidity compared with the POC group (P = .235).Conclusions:Primary tumour resection could improve the survival of patients with asmCRC. Compared with POC or PC, UFC was associated with a better median PFS without significantly increasing preoperative or postoperative morbidity.

Molecular and biological aspects of forecasting the oncological efficiency of cytoreductive surgery in metastatic colon cancer

Through an immunohistochemical study, the molecular biological properties of adenocarcinoma in patients with stage IV colorectal cancer with synchronous unresectable liver metastases, who underwent cytoreductive interventions for volume removal of the primary tumor, were examined. This study clarified the criteria for selecting patients with stage IV colon cancer with unresectable synchronous metastases in the liver for cytoreductive surgery from the standpoint of the molecular biological properties of the tumor. The prognostic significance of immunohistochemical markers such as the index of proliferative activity of stem cancer cells (ALDH + Ki-67 +) and the receptor for chemokines CXCR4 was established. The level of their expression correlates with the life expectancy of patients who underwent cytoreductive surgery. Thus, the high proliferative activity of cancer stem cells (ALDH + Ki67 + 50%) and the high expression of chemokine receptor (CXCR4 70%) correlate with the rapid disease progression after surgical treatment. A significant inverse relationship was traced between the expression level of the receptor for chemokine CXCR4 as well as the proliferative activity of cancer stem cells and life expectancy of patients with stage IV colon cancer after cytoreductive surgery. The expediency of immunohistochemical studies in patients with metastatic colon cancer has been substantiated. Its implementation provides important information about the potential for tumor aggressiveness, which makes it possible to clarify the indications for performing cytoreductive surgery and improve the results of surgical treatment of this category of patients.

Primary Tumor Resection in Colorectal Cancer with Unresectable Synchronous Metastasis: Time to Reconsider the Role of the Surgeon.

Primary Tumor Resection in Colorectal Cancer with Unresectable Synchronous Metastasis: Time to Reconsider the Role of the Surgeon.

A randomized phase III trial comparing primary tumor resection plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer: JCOG1007 study (iPACS).

7 Background: It is still controversial whether primary tumor resection (PTR) before chemotherapy (CTX) improves overall survival (OS) of colorectal cancer (CRC) patients (pts) with synchronous unresectable metastases. There are several retrospective analyses suggesting better outcomes in pts who underwent PTR compared to pts without it, but no prospective studies confirming these results. We conducted a randomized controlled trial to confirm the superiority of PTR plus CTX to CTX alone in asymptomatic unresectable stage IV CRC patients. Methods: Eligibility criteria included histologically proven colon and upper rectal adenocarcinoma, cT1-4 without involvement of other organs, presence of three or less unresectable factors confined to either liver, lungs, distant lymph nodes, or peritoneum, aged 20-74, no symptoms due to primary tumor and PS 0-1. Eligible patients were randomized to either PTR followed by CTX or CTX alone. CTX regimens were declared before study entry; options included mFOLFOX6 plus bevacizumab or CapeOX plus bevacizumab. The primary endpoint was the OS. The planned sample size was 140 pts per arm, with one-sided alpha of 5%, and 70% power detecting a median OS difference of 8 months (24 months vs. 32 months). Results: Between Jun 2012 and Apr 2019, 160 patients were randomized. 78 pts were allocated to PTR plus CTX, and 82 pts to CTX alone. When the first interim analysis was performed in Sep 2019, with 50% (114/227) of the expected events observed, the DSMC recommended the early termination of the trial based on its futility. With a median follow-up period of 22.0 months for 160 patients, median OS was25.9 months (95% CI 19.9 – 31.5) with PTR plus CTX and 26.7(21.9 – 32.5) with CTX alone (hazard ratio 1.10 [0.76 – 1.59], one-sided p = 0.69). Median PFS was 10.4 (8.6-13.4) with PTR plus CTX and 12.1 (9.4 – 13.2) with CTX alone (hazard ratio 1.08 [0.77 – 1.50]). There were three treatment related deaths following PTR due to postoperative complications. Conclusions: PTR followed by CTX has no survival benefit over CTX alone. PTR is not recommended for CRC patients with asymptomatic primary tumor and synchronous unresectable metastases. Clinical trial information: UMIN000008147.

Complete Response of Residual Liver Lesions After Primary Aggressive Surgical Therapy Followed by Chemotherapy in Initially Unresectable Extensive Synchronous Colorectal Liver Metastasis: A Case Report and Literature Review

Complete Response of Residual Liver Lesions After Primary Aggressive Surgical Therapy Followed by Chemotherapy in Initially Unresectable Extensive Synchronous Colorectal Liver Metastasis: A Case Report and Literature Review

Surgical Treatment of Non-Functioning Pancreatic Neuroendocrine Tumours Based on Three Clinical Scenarios

IntroductionThe treatment of patients with non-functioning pancreatic neuroendocrine tumours (NFPNET) is resection in locally pancreatic disease, or with resectable liver metastases. There is controversy about unresectable liver disease. MethodsWe analysed the perioperative data and survival outcome of 63 patients who underwent resection of NFPNET between 1993 and 2012. They were divided into 3 scenarios: A, pancreatic resection (44 patients); B, pancreatic and liver resection in synchronous resectable liver metastases (12 patients); and C, pancreatic resection in synchronous unresectable liver metastases (6 patients). The prognostic factors for survival and recurrence were studied. ResultsDistal pancreatectomy (51%) and pancreaticoduodenectomy (38%) were more frequently performed. Associated surgery was required in 44% of patients, including synchronous liver resections in 9 patients. Two patients received a liver transplant during follow-up. According to the WHO classification they were distributed into G1: 10 (16%), G2: 45 (71%), and G3: 8 (13%). The median hospital stay was 11 days. Postoperative morbidity and mortality were 49% and 1.6%, respectively. At the closure of the study, 43 (68%) patients were still alive, with a mean actuarial survival of 9.6 years. The WHO classification and tumour recurrence were risk factors of mortality in the multivariate analysis. The median actuarial survival by scenarios was 131 months (A), 102 months (B), and 75 months (C) without statistically significant differences. ConclusionsSurgical resection is the treatment for NFPNET without distant disease. Resectable liver metastases in well-differentiated tumours must be resected. The resection of the pancreatic tumour with unresectable synchronous liver metastasis must be considered in well-differentiated NFPNET. The WHO classification grade and recurrence are risk factors of long-term mortality.

Tratamiento quirúrgico de los tumores neuroendocrinos no funcionantes de páncreas basado en 3 escenarios clínicos

IntroductionThe treatment of patients with non-functioning pancreatic neuroendocrine tumours (NFPNET) is resection in locally pancreatic disease, or with resectable liver metastases. There is controversy about unresectable liver disease. MethodsWe analysed the perioperative data and survival outcome of 63 patients who underwent resection of NFPNET between 1993 and 2012. They were divided into 3 scenarios: A, pancreatic resection (44patients); B, pancreatic and liver resection in synchronous resectable liver metastases (12patients); and C, pancreatic resection in synchronous unresectable liver metastases (6patients). The prognostic factors for survival and recurrence were studied. ResultsDistal pancreatectomy (51%) and pancreaticoduodenectomy (38%) were more frequently performed. Associated surgery was required in 44% of patients, including synchronous liver resections in 9patients. Two patients received a liver transplant during follow-up. According to the WHO classification they were distributed into G1: 10 (16%), G2: 45 (71%), and G3: 8 (13%). The median hospital stay was 11days. Postoperative morbidity and mortality were 49% and 1.6%, respectively. At the closure of the study, 43 (68%) patients were still alive, with a mean actuarial survival of 9.6years. The WHO classification and tumour recurrence were risk factors of mortality in the multivariate analysis. The median actuarial survival by scenarios was 131months (A), 102months (B), and 75months (C) without statistically significant differences. ConclusionsSurgical resection is the treatment for NFPNET without distant disease. Resectable liver metastases in well-differentiated tumours must be resected. The resection of the pancreatic tumour with unresectable synchronous liver metastasis must be considered in well-differentiated NFPNET. The WHO classification grade and recurrence are risk factors of long-term mortality.

455. Surgical strategies and outcomes in patients with initially unresectable synchronous liver metastasis from colorectal cancer

455. Surgical strategies and outcomes in patients with initially unresectable synchronous liver metastasis from colorectal cancer

Managing the Primary Tumor with Unresectable Synchronous Colorectal Metastases

Colorectal cancer is the third most commonly diagnosed cancer in men and the second most common in women. Approximately 20 % of patients with colorectal cancer are found to have metastatic disease (stage IV) at the time of diagnosis. A multidisciplinary approach provides the best chance for a potentially curative option in selected patients with metastases, but in most patients, the metastases are unresectable. The treatment strategy for this entity is not fully established, especially regarding whether and when the primary tumor should be resected. In this manuscript, we review current evidence regarding approaches to the primary tumor in patients with unresectable synchronous metastases from colorectal cancer.

Colon cancer with unresectable synchronous metastases: the AAAP scoring system for predicting the outcome after primary tumour resection.

The aim of this study was to develop a prognostic scoring system to predict the outcome of patients with unresectable metastatic colon cancer who received primary colon tumour resection. Patients with confirmed metastatic colon cancer treated at the Peking University Cancer Hospital between 2003 and 2012 were reviewed retrospectively. The correlation of clinicopathological factors with overall survival was analysed using the Kaplan-Meier method and the log-rank test. Independent prognostic factors were identified using a Cox proportional hazards regression model and were then combined to form a prognostic scoring system. A total of 110 eligible patients were included in the study. The median survival time was 10.4months and the 2-year overall survival (OS) rate was 21.8%. Age over 70years, an alkaline phosphatase (ALP) level over 160IU/l, ascites, a platelet/lymphocyte ratio (PLR) above 162 and no postoperative therapy were independently associated with a shorter OS in multivariate analysis. Age, ALP, ascites and PLR were subsequently combined to form the so-called AAAP scoring system. Patients were classified into high, medium and low risk groups according to the score obtained. There were significant differences in OS between each group (P<0.001). Age, ALP, ascites, PLR and postoperative therapy were independent prognostic factors for survival of patients with metastatic colonic cancer who underwent primary tumour resection. The AAAP scoring system may be a useful tool for surgical decision making.

Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: Final overall survival analysis of phase II study.

726 Background: A palliative surgery and chemotherapy is the standard of care in stage IV rectal cancer patients with pelvic symptoms. Recently we published primary results of the single-arm phase II study on combination of short-course radiation (5x5 Gy) with an oxaliplatin-based chemotherapy started after one-week rest (NCT01157806). The study met its primary end-point with only 17.5% (95% CI 13% to 22%) of patients (pts) who needed stoma throughout the observation and 67% (95% CI 58% to 76%) of pts having significant resolution of pelvic symptoms. Here we provide the long-term follow up data after median 60 months of observation. Methods: 40 consecutive patients with symptomatic rectal cancer with unresectable distant metastases were enrolled from September 2009 to February 2011. The time of treatment failure on chemotherapy (TTF3) was measured from the start of radiation to disease progression on fluoropiridine, oxaliplatin and irinotecan. All eligible patients were assessed for KRAS/NRAS status. Due to limitations in access to targeted agents none of patients were treated with anti-angiogenic agents and anti-EGFR treatment was restricted to third line. Results: Total 40 pts were assessed for pelvic symptoms, chemotherapy response and overall survival. In the group of patients with survival reaching over 2 years we have not observed any additional local complications which were treated surgically. The patients with total symptoms’ resolution after one month had significantly longer time-to-treatment failure (TTF3) than non-responders (median 22.5 vs 5 months, p &lt; 0.05), while patients with minor local response had intermediate TTF3. The subgroup of patients who experienced clinical complete response of rectal tumor had a median TTF3 and overall survival reaching median 40 months. Conclusions: In the palliative setting short-course radiotherapy and early chemotherapy allowed for acceptable and durable local control. Metastatic rectal cancer patients with early symptomatic response of primary tumor had significantly better prognosis. Clinical trial information: NCT01157806.

The CAIRO4 study: The role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer—A randomized phase III study of the Dutch Colorectal Cancer Group (DCCG).

TPS782 Background: There is no consensus regarding resection of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastatic colorectal cancer. A potential benefit of resection of the primary tumour is to prevent complications of the primary tumour in later stages of the disease. Retrospective studies also show a potential survival benefit for patients undergoing resection. However, surgery can cause severe morbidity and mortality in this patient group. We hereby propose a randomized trial in order to demonstrate that resection of the primary tumour improves overall survival. Methods: The CAIRO4 study is a multicentre, randomized, phase III study of the Dutch Colorectal Cancer Group (DCCG). Patients with synchronous unresectable metastases of colorectal cancer and few or absent symptoms of the primary tumour are randomized 1:1 between systemic therapy only, and resection of the primary tumour followed by systemic therapy. Patients will be stratified according to location of the primary tumour (colon versus rectum), WHO performance status (0-1 versus 2), hospital of inclusion, serum LDH (normal versus abnormal) and number of metastatic sites (single versus multiple). To demonstrate a survival benefit of 6 months in the experimental arm, a total of 218 events are needed (80% power, significance lever 0.05). Accounting for accrual time and follow-up, we need a total of 360 patients (180 patients per arm). Systemic therapy will consist of fluoropyrimidine-based chemotherapy in combination with bevacizumab. The primary objective of this study is to determine the clinical benefit in terms of overall survival of initial resection of the primary tumour. Secondary endpoints include progression free survival, surgical morbidity, quality of life and the number of patients requiring resection of the primary tumour in the control arm. Accrual has started in September 2012. As of January 2015, 64 centres in the Netherlands and Denmark are participating in the CAIRO4 study. Clinical trial information: NCT01606098.

Survival impact of primary tumor resection in patients (pts) with unresectable metastatic colorectal cancer (mCRC): Findings from the South Australian Metastatic Colorectal Cancer Registry (SAMCRC).

e14675 Background: The impact of primary tumor resection on survival in pts with mCRC and unresectable synchronous metastases is unclear. We aimed to examine the association of primary tumor resect...

The value of primary tumor resection in patients with metastatic colorectal cancer received chemotherapy plus bevacizumab: Results from the single center, retrospective study.

e14615 Background: The role of primary tumor resection ( PTR ) in colorectal cancer patients with synchronous unresectable metastases are still controversial. The addition of bevacizumab to chemoth...

The CAIRO4 study: The role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer—A randomized phase III study of the Dutch Colorectal Cancer Group (DCCG).

The CAIRO4 study: The role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer—A randomized phase III study of the Dutch Colorectal Cancer Group (DCCG).