Clinical Trial

. 2024 Sep;35(9):769-779.

doi: 10.1016/j.annonc.2024.06.001. Epub 2024 Jun 7.

Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group

D E W van der Kruijssen¹, S G Elias², P M van de Ven², K L van Rooijen¹, J 't Lam-Boer³, L Mol⁴, C J A Punt², D W Sommeijer⁵, P J Tanis⁶, J D Nielsen⁷, M K Yilmaz⁸, J M G H van Riel⁹, D K Wasowiz-Kemps¹⁰, O J L Loosveld¹¹, G P van der Schelling¹², J W B de Groot¹³, H L van Westreenen¹⁴, H L Jakobsen¹⁵, A L Fromm¹⁶, P Hamberg¹⁷, M Verseveld¹⁸, C Jaensch¹⁹, G I Liposits²⁰, P van Duijvendijk²¹, J Oulad Hadj²², J A B van der Hoeven²³, M Trajkovic²⁴, J H W de Wilt²⁵, M Koopman²⁶; CAIRO4 Working Group

Collaborators, Affiliations

Collaborators

CAIRO4 Working Group:
Jeroen Vincent²⁷, Johannes A Wegdam²⁸, Brigitte C M Haberkorn²⁹, Erwin van der Harst³⁰, Mathijs P Hendriks³¹, W H Hermien Schreurs³², Huib A Cense³³, Ron C Rietbroek³⁴, Marie-José de Gier³⁵, Edwin A van Breugel³⁶, Aad I de Vos³⁷, Rebecca P M Brosens³⁸, P G Doornebosch³⁹, Felix E de Jongh⁴⁰, Wouter J Vles⁴¹, Marien O den Boer⁴², Jeroen W A Leijtens⁴³, A J Hans Gelderblom⁴⁴, Koen C M J Peeters⁴⁵, Bart C Kuenen⁴⁶, Bareld B Pultrum⁴⁷, Joyce M van Dodewaard-de Jong⁴⁸, Esther C J Consten⁴⁹, A J Yes van de Wouw⁵⁰, J L M Konsten⁵¹, R Hoekstra⁵², Martijn F Lutke Holzik⁵³, Allert H Vos⁵⁴, M J van Hoogstraten⁵⁵, Nis H Schlesinger⁵⁶, Geert-Jan Creemers⁵⁷, Ignace H J T de Hingh⁵⁸, Monica L Kjær⁵⁹, Lone N Petersen⁶⁰, Michael Seiersen⁶¹, Rahim Altaf⁶², Hester van Cruijsen⁶³, Daniël A Hess⁶⁴, Lobke L van Leeuwen-Snoeks⁶⁵, Apollo Pronk⁶⁶, Coen I M Baeten⁶⁷, Wendy M van der Deure⁶⁸, Koop Bosscha⁶⁹, Heidi Schut⁷⁰, W K G Leclercq⁷¹, L H J Simkens⁷², Koen Reijnders⁷³, Kees van Arkel⁷⁴, W M U Helma van Grevenstein⁷⁵, Anthony W H van de Ven⁷⁶, Ronald J C L M Vuylsteke⁷⁷, Philomeen Kuijer⁷⁸, Sandra D Bakker⁷⁹, Hauwy Goei⁸⁰, Helgi H Helgason⁸¹, Gijs J D van Acker⁸², Mehmet Temizkan⁸³, Marc W A van Tilburg⁸⁴, Michael F Gerhards⁸⁵, E D Kerver⁸⁶, Elske Gootjes⁸⁷, Peter Nieboer⁸⁸, Wim A Bleeker⁸⁹, G R Bleeker⁹⁰

Affiliations

¹ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht.
² Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
³ Department of Surgery, Radboud University Medical Center, Nijmegen; Department of Surgery, Netherlands Cancer Institute, Amsterdam.
⁴ Clinical Research Department, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht.
⁵ Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam; Department of Medical Oncology, Flevo Hospital, Almere.
⁶ Department of Surgery, Amsterdam University Medical Center, Amsterdam; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
⁷ Department of Surgery, Aalborg University Hospital, Aalborg, Denmark.
⁸ Department of Medical Oncology, Aalborg University Hospital, Aalborg, Denmark.
⁹ Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg.
¹⁰ Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg.
¹¹ Department of Medical Oncology, Amphia Hospital, Breda.
¹² Department of Surgery, Amphia Hospital, Breda.
¹³ Department of Medical Oncology, Isala Hospital, Zwolle, The Netherlands.
¹⁴ Department of Surgery, Isala Hospital, Zwolle, The Netherlands.
¹⁵ Department of Surgery, Herlev and Gentofte Hospital, Herlev, Denmark.
¹⁶ Department of Medical Oncology, Herlev and Gentofte Hospital, Herlev, Denmark.
¹⁷ Department of Medical Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
¹⁸ Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
¹⁹ Department of Surgery, Regional Hospital Gødstrup, Herning, Denmark.
²⁰ Department of Medical Oncology, Regional Hospital Gødstrup, Herning, Denmark.
²¹ Department of Surgery, Gelre Hospital, Apeldoorn.
²² Department of Medical Oncology, Gelre Hospital, Apeldoorn.
²³ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
²⁴ Department of Medical Oncology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
²⁵ Department of Surgery, Radboud University Medical Center, Nijmegen.
²⁶ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht. Electronic address: M.Koopman-6@umcutrecht.nl.
²⁷ Department of Medical Oncology, Elkerliek Hospital, Helmond, The Netherlands.
²⁸ Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands.
²⁹ Department of Medical Oncology, Maasstad Hospital, Rotterdam, The Netherlands.
³⁰ Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
³¹ Department of Medical Oncology, Northwest Clinics Alkmaar, Alkmaar, The Netherlands.
³² Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, The Netherlands.
³³ Department of Surgery, Rode Kruis Hospital, Beverwijk, The Netherlands.
³⁴ Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, The Netherlands.
³⁵ Department of Medical Oncology, IJselland Hospital, Capelle aan den IJssel, The Netherlands.
³⁶ Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands.
³⁷ Department of Medical Oncology, Dijklander Hospital, Hoorn, The Netherlands.
³⁸ Department of Medical Oncology, Het Van Weel-Bethesda Hospital, Dirksland, The Netherlands.
³⁹ Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, The Netherlands.
⁴⁰ Department of Surgery, IJselland Hospital Capelle aan den IJssel, The Netherlands.
⁴¹ Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands.
⁴² Department of Medical Oncology, Laurentius Hospital, Roermond, The Netherlands.
⁴³ Department of Surgery, Laurentius Hospital Roermond, Roermond, The Netherlands.
⁴⁴ Department of Medical Oncology, Leiden Univeristy Medical Center, Leiden, The Netherlands.
⁴⁵ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁴⁶ Department of Medical Oncology, Martini Hospital, Groningen, The Netherlands.
⁴⁷ Department of Surgery, Martini Hospital, Groningen, The Netherlands.
⁴⁸ Department of Medical Oncology, Meander Medical Center, Amersfoort, The Netherlands.
⁴⁹ Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
⁵⁰ Department of Medical Oncology, Viecuri Medical Center, Venlo, The Netherlands.
⁵¹ Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands.
⁵² Department of Medical Oncology, Ziekenhuisgroep Twente, Almelo, The Netherlands.
⁵³ Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands.
⁵⁴ Department of Medical Oncology, Bernhoven, Uden, The Netherlands.
⁵⁵ Department of Surgery, Bernhoven, Uden, The Netherlands.
⁵⁶ Department of Surgery, Bispebjerg Hospital, Copenhagen, Denmark.
⁵⁷ Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
⁵⁸ Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
⁵⁹ Department of Surgery, Hvidovre Hospital, Hvidovre, Denmark.
⁶⁰ Department of Medical Oncology, Rigshospitalet, Copenhagen, Denmark.
⁶¹ Department of Surgery, Roskilde Hospital, Roskilde, Denmark.
⁶² Department of Medical Oncology, Roskilde Hospital, Roskilde, Denmark.
⁶³ Department of Medical Oncology, Antonius Hospital Sneek, Sneek, The Netherlands.
⁶⁴ Department of Surgery, Antonius Hospital Sneek, Sneek, The Netherlands.
⁶⁵ Department of Medical Oncology, Diakonessenhuis, Utrecht, The Netherlands.
⁶⁶ Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
⁶⁷ Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.
⁶⁸ Department of Medical Oncology, Groene Hart Hospital, Gouda, The Netherlands.
⁶⁹ Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
⁷⁰ Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
⁷¹ Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
⁷² Department of Medical Oncology, Máxima Medical Center, Veldhoven, The Netherlands.
⁷³ Department of Surgery, Slingeland Hospital, Doetinchem, The Netherlands.
⁷⁴ Department of Medical Oncology, Slingeland Hospital, Slingeland Hospital, Doetinchem, The Netherlands.
⁷⁵ Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷⁶ Department of Surgery, Flevo hospital, Almere, The Netherlands.
⁷⁷ Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands.
⁷⁸ Department of Medical Oncology, Spaarne Gasthuis, Haarlem, The Netherlands.
⁷⁹ Department of Medical Oncology, Zaans Medical Center, Noord-Holland, The Netherlands.
⁸⁰ Department of Surgery, Zaans Medical Center, Noord-Holland, The Netherlands.
⁸¹ Department of Medical Oncology, Haaglanden Medical Center, Den Haag, The Netherlands.
⁸² Department of Surgery, Haaglanden Medical Center, Den Haag, The Netherlands.
⁸³ Department of Medical Oncology, Hospital St. Jansdal, Harderwijk, The Netherlands.
⁸⁴ Department of Surgery, Hospital St. Jansdal, Harderwijk, The Netherlands.
⁸⁵ Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
⁸⁶ Department of Medical Oncology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
⁸⁷ Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁸⁸ Department of Medical Oncology, Wilhelmina Hospital Assen, Assen, The Netherlands.
⁸⁹ Department of Surgery, Wilhelmina Hospital Assen, Assen, the Netherlands.
⁹⁰ Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL).

PMID: 38852675
DOI: 10.1016/j.annonc.2024.06.001

Free article

Clinical Trial

Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group

D E W van der Kruijssen et al. Ann Oncol. 2024 Sep.

Free article

. 2024 Sep;35(9):769-779.

doi: 10.1016/j.annonc.2024.06.001. Epub 2024 Jun 7.

Authors

Collaborators

CAIRO4 Working Group:
Jeroen Vincent²⁷, Johannes A Wegdam²⁸, Brigitte C M Haberkorn²⁹, Erwin van der Harst³⁰, Mathijs P Hendriks³¹, W H Hermien Schreurs³², Huib A Cense³³, Ron C Rietbroek³⁴, Marie-José de Gier³⁵, Edwin A van Breugel³⁶, Aad I de Vos³⁷, Rebecca P M Brosens³⁸, P G Doornebosch³⁹, Felix E de Jongh⁴⁰, Wouter J Vles⁴¹, Marien O den Boer⁴², Jeroen W A Leijtens⁴³, A J Hans Gelderblom⁴⁴, Koen C M J Peeters⁴⁵, Bart C Kuenen⁴⁶, Bareld B Pultrum⁴⁷, Joyce M van Dodewaard-de Jong⁴⁸, Esther C J Consten⁴⁹, A J Yes van de Wouw⁵⁰, J L M Konsten⁵¹, R Hoekstra⁵², Martijn F Lutke Holzik⁵³, Allert H Vos⁵⁴, M J van Hoogstraten⁵⁵, Nis H Schlesinger⁵⁶, Geert-Jan Creemers⁵⁷, Ignace H J T de Hingh⁵⁸, Monica L Kjær⁵⁹, Lone N Petersen⁶⁰, Michael Seiersen⁶¹, Rahim Altaf⁶², Hester van Cruijsen⁶³, Daniël A Hess⁶⁴, Lobke L van Leeuwen-Snoeks⁶⁵, Apollo Pronk⁶⁶, Coen I M Baeten⁶⁷, Wendy M van der Deure⁶⁸, Koop Bosscha⁶⁹, Heidi Schut⁷⁰, W K G Leclercq⁷¹, L H J Simkens⁷², Koen Reijnders⁷³, Kees van Arkel⁷⁴, W M U Helma van Grevenstein⁷⁵, Anthony W H van de Ven⁷⁶, Ronald J C L M Vuylsteke⁷⁷, Philomeen Kuijer⁷⁸, Sandra D Bakker⁷⁹, Hauwy Goei⁸⁰, Helgi H Helgason⁸¹, Gijs J D van Acker⁸², Mehmet Temizkan⁸³, Marc W A van Tilburg⁸⁴, Michael F Gerhards⁸⁵, E D Kerver⁸⁶, Elske Gootjes⁸⁷, Peter Nieboer⁸⁸, Wim A Bleeker⁸⁹, G R Bleeker⁹⁰

Affiliations

¹ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht.
² Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
³ Department of Surgery, Radboud University Medical Center, Nijmegen; Department of Surgery, Netherlands Cancer Institute, Amsterdam.
⁴ Clinical Research Department, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht.
⁵ Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam; Department of Medical Oncology, Flevo Hospital, Almere.
⁶ Department of Surgery, Amsterdam University Medical Center, Amsterdam; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
⁷ Department of Surgery, Aalborg University Hospital, Aalborg, Denmark.
⁸ Department of Medical Oncology, Aalborg University Hospital, Aalborg, Denmark.
⁹ Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg.
¹⁰ Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg.
¹¹ Department of Medical Oncology, Amphia Hospital, Breda.
¹² Department of Surgery, Amphia Hospital, Breda.
¹³ Department of Medical Oncology, Isala Hospital, Zwolle, The Netherlands.
¹⁴ Department of Surgery, Isala Hospital, Zwolle, The Netherlands.
¹⁵ Department of Surgery, Herlev and Gentofte Hospital, Herlev, Denmark.
¹⁶ Department of Medical Oncology, Herlev and Gentofte Hospital, Herlev, Denmark.
¹⁷ Department of Medical Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
¹⁸ Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
¹⁹ Department of Surgery, Regional Hospital Gødstrup, Herning, Denmark.
²⁰ Department of Medical Oncology, Regional Hospital Gødstrup, Herning, Denmark.
²¹ Department of Surgery, Gelre Hospital, Apeldoorn.
²² Department of Medical Oncology, Gelre Hospital, Apeldoorn.
²³ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
²⁴ Department of Medical Oncology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
²⁵ Department of Surgery, Radboud University Medical Center, Nijmegen.
²⁶ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht. Electronic address: M.Koopman-6@umcutrecht.nl.
²⁷ Department of Medical Oncology, Elkerliek Hospital, Helmond, The Netherlands.
²⁸ Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands.
²⁹ Department of Medical Oncology, Maasstad Hospital, Rotterdam, The Netherlands.
³⁰ Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
³¹ Department of Medical Oncology, Northwest Clinics Alkmaar, Alkmaar, The Netherlands.
³² Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, The Netherlands.
³³ Department of Surgery, Rode Kruis Hospital, Beverwijk, The Netherlands.
³⁴ Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, The Netherlands.
³⁵ Department of Medical Oncology, IJselland Hospital, Capelle aan den IJssel, The Netherlands.
³⁶ Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands.
³⁷ Department of Medical Oncology, Dijklander Hospital, Hoorn, The Netherlands.
³⁸ Department of Medical Oncology, Het Van Weel-Bethesda Hospital, Dirksland, The Netherlands.
³⁹ Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, The Netherlands.
⁴⁰ Department of Surgery, IJselland Hospital Capelle aan den IJssel, The Netherlands.
⁴¹ Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands.
⁴² Department of Medical Oncology, Laurentius Hospital, Roermond, The Netherlands.
⁴³ Department of Surgery, Laurentius Hospital Roermond, Roermond, The Netherlands.
⁴⁴ Department of Medical Oncology, Leiden Univeristy Medical Center, Leiden, The Netherlands.
⁴⁵ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁴⁶ Department of Medical Oncology, Martini Hospital, Groningen, The Netherlands.
⁴⁷ Department of Surgery, Martini Hospital, Groningen, The Netherlands.
⁴⁸ Department of Medical Oncology, Meander Medical Center, Amersfoort, The Netherlands.
⁴⁹ Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
⁵⁰ Department of Medical Oncology, Viecuri Medical Center, Venlo, The Netherlands.
⁵¹ Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands.
⁵² Department of Medical Oncology, Ziekenhuisgroep Twente, Almelo, The Netherlands.
⁵³ Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands.
⁵⁴ Department of Medical Oncology, Bernhoven, Uden, The Netherlands.
⁵⁵ Department of Surgery, Bernhoven, Uden, The Netherlands.
⁵⁶ Department of Surgery, Bispebjerg Hospital, Copenhagen, Denmark.
⁵⁷ Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands.
⁵⁸ Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
⁵⁹ Department of Surgery, Hvidovre Hospital, Hvidovre, Denmark.
⁶⁰ Department of Medical Oncology, Rigshospitalet, Copenhagen, Denmark.
⁶¹ Department of Surgery, Roskilde Hospital, Roskilde, Denmark.
⁶² Department of Medical Oncology, Roskilde Hospital, Roskilde, Denmark.
⁶³ Department of Medical Oncology, Antonius Hospital Sneek, Sneek, The Netherlands.
⁶⁴ Department of Surgery, Antonius Hospital Sneek, Sneek, The Netherlands.
⁶⁵ Department of Medical Oncology, Diakonessenhuis, Utrecht, The Netherlands.
⁶⁶ Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
⁶⁷ Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.
⁶⁸ Department of Medical Oncology, Groene Hart Hospital, Gouda, The Netherlands.
⁶⁹ Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
⁷⁰ Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
⁷¹ Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
⁷² Department of Medical Oncology, Máxima Medical Center, Veldhoven, The Netherlands.
⁷³ Department of Surgery, Slingeland Hospital, Doetinchem, The Netherlands.
⁷⁴ Department of Medical Oncology, Slingeland Hospital, Slingeland Hospital, Doetinchem, The Netherlands.
⁷⁵ Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷⁶ Department of Surgery, Flevo hospital, Almere, The Netherlands.
⁷⁷ Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands.
⁷⁸ Department of Medical Oncology, Spaarne Gasthuis, Haarlem, The Netherlands.
⁷⁹ Department of Medical Oncology, Zaans Medical Center, Noord-Holland, The Netherlands.
⁸⁰ Department of Surgery, Zaans Medical Center, Noord-Holland, The Netherlands.
⁸¹ Department of Medical Oncology, Haaglanden Medical Center, Den Haag, The Netherlands.
⁸² Department of Surgery, Haaglanden Medical Center, Den Haag, The Netherlands.
⁸³ Department of Medical Oncology, Hospital St. Jansdal, Harderwijk, The Netherlands.
⁸⁴ Department of Surgery, Hospital St. Jansdal, Harderwijk, The Netherlands.
⁸⁵ Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
⁸⁶ Department of Medical Oncology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
⁸⁷ Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁸⁸ Department of Medical Oncology, Wilhelmina Hospital Assen, Assen, The Netherlands.
⁸⁹ Department of Surgery, Wilhelmina Hospital Assen, Assen, the Netherlands.
⁹⁰ Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL).

PMID: 38852675
DOI: 10.1016/j.annonc.2024.06.001

Abstract

Background: Upfront primary tumor resection (PTR) has been associated with longer overall survival (OS) in patients with synchronous unresectable metastatic colorectal cancer (mCRC) in retrospective analyses. The aim of the CAIRO4 study was to investigate whether the addition of upfront PTR to systemic therapy resulted in a survival benefit in patients with synchronous mCRC without severe symptoms of their primary tumor.

Patients and methods: This randomized phase III trial was conducted in 45 hospitals in The Netherlands and Denmark. Eligibility criteria included previously untreated mCRC, unresectable metastases, and no severe symptoms of the primary tumor. Patients were randomized (1 : 1) to upfront PTR followed by systemic therapy or systemic therapy without upfront PTR. Systemic therapy consisted of first-line fluoropyrimidine-based chemotherapy with bevacizumab in both arms. Primary endpoint was OS in the intention-to-treat population. The study was registered at ClinicalTrials.gov, NCT01606098.

Results: Between August 2012 and February 2021, 206 patients were randomized. In the intention-to-treat analysis, 204 patients were included (n = 103 without upfront PTR, n = 101 with upfront PTR) of whom 116 were men (57%) with median age of 65 years (interquartile range 59-71 years). Median follow-up was 69.4 months. Median OS in the arm without upfront PTR was 18.3 months (95% confidence interval 16.0-22.2 months) compared with 20.1 months (95% confidence interval 17.0-25.1 months) in the upfront PTR arm (P = 0.32). The number of grade 3-4 events was 71 (72%) in the arm without upfront PTR and 61 (65%) in the upfront PTR arm (P = 0.33). Three deaths (3%) possibly related to treatment were reported in the arm without upfront PTR and four (4%) in the upfront PTR arm.

Conclusions: Addition of upfront PTR to palliative systemic therapy in patients with synchronous mCRC without severe symptoms of the primary tumor does not result in a survival benefit. This practice should no longer be considered standard of care.

Keywords: metastatic colorectal cancer; primary tumor resection; systemic therapy.

PubMed Disclaimer

Cited by

Impact on survival benefits of asymptomatic primary tumor resection after bevacizumab plus FOLFIRI as first-line therapy for patients with metastatic colorectal cancer with synchronous unresectable metastasis.
Chen YC, Chang TK, Su WC, Yeh YS, Chen PJ, Huang PJ, Yang PH, Tsai HL, Wang JY, Huang CW. Chen YC, et al. Int J Colorectal Dis. 2024 Oct 25;39(1):171. doi: 10.1007/s00384-024-04745-1. Int J Colorectal Dis. 2024. PMID: 39453531 Free PMC article.
Outcomes of upfront primary tumor resection in patients with synchronous RAS wild-type metastatic colorectal cancer.
Chen PJ, Chen CC, Chang SC, Chang YY, Lin BW, Chen HH, Hsieh YY, Hsu HC, Hsieh MC, Ke TW, Kuan FC, Wu CC, Lu WC, Su YL, Liang YH, Chen JB, Huang SY, Huang CW, Wang JY. Chen PJ, et al. Am J Cancer Res. 2024 Dec 15;14(12):5863-5873. doi: 10.62347/DLWI1455. eCollection 2024. Am J Cancer Res. 2024. PMID: 39803657 Free PMC article.
Factors Influencing the Duration of Maintenance Therapy in Metastatic Colorectal Cancer.
Fourrier T, Truntzer C, Peroz M, Derangère V, Vincent J, Bengrine-Lefèvre L, Hennequin A, Palmier R, Orry D, Rabel T, Ghiringhelli F. Fourrier T, et al. Cancers (Basel). 2024 Dec 30;17(1):88. doi: 10.3390/cancers17010088. Cancers (Basel). 2024. PMID: 39796718 Free PMC article.

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

LinkOut - more resources

Full Text Sources
- Elsevier Science
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group

Collaborators

Affiliations

Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group

Authors

Collaborators

Affiliations

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Substances

Associated data

Related information

LinkOut - more resources

Full Text Sources

Medical