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Published: 2021

Total Pages: 0

ISBN-13: 9789464232318

Colorectal cancer Colorectal cancer is the third most common malignant tumor worldwide. Globally, more than 600.000 people die from colorectal cancer every year, mainly from metastatic disease. Before the era of chemotherapy, patients with mCRC had a median overall survival of 9 months. With the introduction chemotherapeutic agents and targeted agents against VEGF and the EGF receptor, overall survival has improved to over 30 months. Originally, when patients presented with metastases, the disease was viewed as always being widespread and patients have typically been treated with systemic therapy. However, local treatment of metastases is technically feasible in an increasing number of patients with mCRC by either resection, radiofrequency ablation or stereotactic radiotherapy. Preliminary and retrospective evidence suggests that patients with extensive multi-organ mCRC may benefit from local treatment of metastases. This results in a growing debate in multidisciplinary teams on whether local treatment of metastases should be performed in these patients. Part One: Debulking in metastatic colorectal cancer In Chapter 2, the rationale of debulking therapy for patients with multi-organ mCRC is reviewed. The ORCHESTRA trial is the first multicenter randomized clinical trial in which is evaluated if multidisciplinary local treatment in addition to first line palliative systemic treatment (NCT01792934) results in survival benefit for patients with extensive mCRC. A preplanned safety and feasibility evaluation was performed aftercompletion of study treatment of the first 100 patients enrolled in the trial and reported in Chapter 3. A translational study program was embedded in the ORCHESTRA trial protocol and blood and tissue samples were collected from all patients enrolled.