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Impact of Palliative Chemotherapy and Surgery on Management of Stage IV Incurable Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent trials proposed chemotherapy (CHT) as the treatment of choice for patients affected by incurable colorectal cancer (ICRC). Nevertheless, surgery is still commonly offered to these patients. On the other hand, CHT is offered to ICRC patients regardless of the pattern of spread of the disease, local or distant, despite some evidence suggesting that metastatic pattern may influence the response to treatment.

Methods

A retrospective analysis was performed of 133 patients undergoing palliative treatment for ICRC from 1994 through 2007. Palliation consisted of surgery alone until 2002 and surgery with CHT (FOLFOX–FOLFIRI) thereafter. The impact of CHT and surgery was evaluated in the whole series as well as with respect to metastatic pattern (locally aggressive primary tumor and distant metastasis only), tumor site, and grading.

Results

Chemotherapy prolonged survival by 9 months (p = 0.001). In patients undergoing CHT, resective surgery did not prolong survival (p = 0.931), whereas in patients not undergoing CHT, it improved prognosis by 5 months (p = 0.023). Considering patients with distant metastasis only, CHT significantly prolonged survival (p < 0.001), whereas it did not improve the prognosis of patients with a locally aggressive primary tumor (p = 0.943). No difference in CHT effectiveness with respect to tumor site and grading was recorded.

Conclusions

CHT should be the preferred option in patients undergoing elective treatment for ICRC, whereas surgery should be considered whenever CHT is not administered. CHT significantly increases survival of patients with unresectable distant metastasis only, whereas it seems to be useless in patients with locally aggressive primary tumors.

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References

  1. Scheithauer W, Rosen H, Kornek GV, Sebesta C, Depisch D. Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ. 1993;306:752–5.

    Article  CAS  PubMed  Google Scholar 

  2. De Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.

    PubMed  Google Scholar 

  3. Cunningham D, Pyrhönen S, James RD, et al. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet. 1998;352:1413–8.

    Article  CAS  PubMed  Google Scholar 

  4. Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.

    Article  CAS  PubMed  Google Scholar 

  5. Costi R, Mazzeo A, Di Mauro D, et al. Palliative resection of colorectal cancer: does it prolong survival? Ann Surg Oncol. 2007;14:2567–76.

    Article  PubMed  Google Scholar 

  6. Sarela AI, Guthrie JA, Seymour MT, Ride E, Guillou PJ, O’Riordain DS. Nonoperative management of the primary tumor in patients with incurable stage IV cancer. Br J Surg. 2001;88:1352–6.

    Article  CAS  PubMed  Google Scholar 

  7. Konyalian VR, Rosing DK, Haukoos JS, et al. The role of primary tumour resection in patients with stage IV colorectal cancer. Colorectal Dis. 2006;9:430–7.

    Article  Google Scholar 

  8. Carne PW, Frye JN, Robertson GM, Frizelle FA. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum. 2004;47:1455–61.

    Article  PubMed  Google Scholar 

  9. Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg. 2003;90:1429–33.

    Article  CAS  PubMed  Google Scholar 

  10. Colorectal Cancer Collaborative Group. Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis. BMJ. 2000;321:531–5.

    Article  Google Scholar 

  11. Silverberg E, Boring CC, Squires TS. Cancer statistics, 1990. CA Cancer J Clin. 1990;40:9–26.

    Article  CAS  PubMed  Google Scholar 

  12. Nordic Gastrointestinal Tumor Adjuvant Therapy Group. Expectancy or primary chemotherapy in patients with advanced asymptomatic colorectal cancer: a randomized trial. J Clin Oncol. 1992;10:904–11.

    Google Scholar 

  13. Lewis JH, Kilgore ML, Goldman DP, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21:1383–9.

    Article  PubMed  Google Scholar 

  14. Gallego R, Sanchez N, Maurel J. Chemotherapy for elderly patients with advanced colorectal carcinoma. Expert Rev Anticancer Ther. 2006;6:795–800.

    Article  CAS  PubMed  Google Scholar 

  15. Harris GJ, Senagore AJ, Lavery IC, Church JM, Fazio VW. Factors affecting survival after palliative resection of colorectal carcinoma. Colorectal Dis. 2002;4:31–5.

    Article  PubMed  Google Scholar 

  16. Kuo LJ, Leu SY, Liu MC, Jian JJ, Hongiun Cheng S, Chen CM. How aggressive should we be in patients with stage IV colorectal cancer? Dis Colon Rectum. 2003;46:1646–52.

    Article  PubMed  Google Scholar 

  17. Rosen SA, Buell JF, Yoshida A, et al. Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg. 2000;135:530–4.

    Article  CAS  PubMed  Google Scholar 

  18. Liu SK, Church JM, Lavery IC, Fazio VW. Operation in patients with incurable colon cancer is it worthwhile? Dis Colon Rectum. 1997;40:11–4.

    Article  CAS  PubMed  Google Scholar 

  19. Cook AD, Single R, McCahill LE. Surgical resection of primary tumors in patients who present with stage IV colorectal cancer: an analysis of surveillance, epidemiology, and end results data, 1988 to 2000. Ann Surg Oncol. 2005;12:637–45.

    Article  PubMed  Google Scholar 

  20. Makela J, Haukipuro K, Laitinen S, Kairaluoma MI. Palliative operations for colorectal cancer. Dis Colon Rectum. 1990;33:846–50.

    Article  CAS  PubMed  Google Scholar 

  21. Cummins ER, Vick KD, Poole GV. Incurable colorectal carcinoma: the role of surgical palliation. Am Surg. 2004;70:433–7.

    PubMed  Google Scholar 

  22. Joffe J, Gordon PH. Palliative resection for colorectal carcinoma. Dis Colon Rectum. 1981;24:355–60.

    Article  CAS  PubMed  Google Scholar 

  23. Scheithauer W, Kornek GV, Raderer M, et al. Intermittent weekly high-dose capecitabine in combination with oxaliplatin: a phase I/II study in first-line treatment of patients with advanced colorectal cancer. Ann Oncol. 2002;13:1583–9.

    Article  CAS  PubMed  Google Scholar 

  24. Saltz LB, Cox JV, Blanke C et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med. 2000;343:905–14.

    Article  CAS  PubMed  Google Scholar 

  25. Goldberg RM, Sargent DJ, Morton RF, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We acknowledge financial support from University of Parma Research Funds.

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Authors and Affiliations

  1. Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Dipartimento di Scienze Chirurgiche, Università di Parma, Parma, Italy

    Renato Costi PhD, Davide Di Mauro MD, Leopoldo Sarli MD, Luigi Roncoroni MD & Vincenzo Violi MD

  2. Service de Chirurgie Digestive et Viscérale, Hôpital Antoine Béclère, Clamart, France

    Renato Costi PhD

  3. Department of Colorectal Surgery, Whipps Cross University Hospital, London, UK

    Pasquale Giordano FRCS

  4. Dipartimento Polispecialistico 1, Unità Operativa di Oncologia Medica, Azienda Ospedaliera Universitaria di Parma, Parma, Italy

    Francesco Leonardi MD

  5. Dipartimento di Sanità Pubblica, Università di Parma, Parma, Italy

    Licia Veronesi MD

Authors
  1. Renato Costi PhD
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  2. Davide Di Mauro MD
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  3. Pasquale Giordano FRCS
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  4. Francesco Leonardi MD
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  5. Licia Veronesi MD
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  6. Leopoldo Sarli MD
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  7. Luigi Roncoroni MD
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  8. Vincenzo Violi MD
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Corresponding author

Correspondence to Renato Costi PhD.

Additional information

This paper was accepted for presentation as an abstract at the 4th Congress of the European Society of Coloproctology, Prague (Czech Republic), September 23–26, 2009.

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Costi, R., Di Mauro, D., Giordano, P. et al. Impact of Palliative Chemotherapy and Surgery on Management of Stage IV Incurable Colorectal Cancer. Ann Surg Oncol 17, 432–440 (2010). https://doi.org/10.1245/s10434-009-0830-9

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  • DOI: https://doi.org/10.1245/s10434-009-0830-9

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