Home > Oncology > ASCO 2022 > Gastrointestinal Cancers > To resect or not to resect primary tumours in stage IV colon cancer?

To resect or not to resect primary tumours in stage IV colon cancer?

Presented by
Prof. Jürgen Weitz, Technische Universität Dresden, Germany
Conference
ASCO 2022
Trial
SYNCHRONOUS
Doi
https://doi.org/10.55788/810df2a6

In patients with colon cancer or high rectal cancer and synchronous unresectable metastases, resection of the primary tumour did not prolong the overall survival (OS) time compared with chemotherapy only. Chemotherapy demonstrated to be the most important factor to influence OS in these patients.

“Resection of the primary tumour in patients with stage IV colorectal cancer is debated,” said

Prof. Jürgen Weitz (Technische Universität Dresden, Germany) at the start of his presentation [1]. It may prevent primary tumour complications, but increases the risk of surgical complications. Current evidence is unclear on whether the primary tumour should be resected in this population [2]. To address this gap in the literature, the SYNCHRONOUS trial (ISRCTN30964555) randomised 393 patients with colon cancer or high rectal cancer, synchronous metastases, and asymptomatic primary tumours to resection plus chemotherapy by physician’s choice or chemotherapy alone [1]. OS was the primary endpoint of this trial.

After a median follow-up of 36 months, no significant difference in OS was measured between the resection plus chemotherapy arm and the chemotherapy alone arm (16.7 vs 18.6 months; P=0.685). Notably, in a subgroup of patients that did not receive chemotherapy (24.1% in resection plus chemotherapy and 6.4% in chemotherapy alone arm), the OS decreased significantly (HR 5.32; P<0.001). In addition, no subgroup appeared to benefit from surgery in addition to chemotherapy in terms of OS.

Serious adverse events were more common in the chemotherapy arm (18.0% vs 10.2%), mainly due to an increased number of gastrointestinal tract-related events (10.7% vs 4.8%; P=0.031).

Prof. Weitz concluded that the addition of resection of the primary tumour to chemotherapy does not prolong OS in patients with colon cancer or high rectal cancer, asymptomatic primary tumours, and synchronous unresectable metastases. In fact, chemotherapy was the most important factor to impact the OS time of these patients.

  1. Rahbari NN, et al. 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, ASCO 2022 Annual Meeting, 3–7 June, Chicago, IL, USA.
  2. Cirocchi R, et al. Cochrane Database Syst Rev. 2012;8:CD008997.

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