Surgical oncologist Philip B. Paty, Vice Chair for Clinical Research in the Department of Surgery, observed that a new treatment approach is warranted for patients with advanced colorectal cancer whose disease has already spread from the colon to other organs at the time of diagnosis.
Traditionally, such patients have been treated with surgery to remove the primary tumor in the colon. "We now know that the routine use of surgery in these patients is based on old thinking, and we're beyond that," Dr. Paty said. "Our default position should be not to operate, although there will always be individual exceptions."
In a retrospective study, he and his colleagues analyzed 233 patients who had been diagnosed with metastatic colorectal cancer and treated with chemotherapy at Memorial Sloan-Kettering. In 93 percent of these patients, the primary tumor did not cause any complications that required it to be removed.
The investigators considered a number of factors, including the tumor's initial location, its extent of spread, and whether bevacizumab had been added to the chemotherapy. None of these correlated with a patient's need for surgical intervention. "If the primary tumor is not causing symptoms such as bleeding or blockage, we've found these patients are best treated with chemotherapy," Dr. Paty commented. "By moving straight to chemotherapy, patients can start treatment for all disease sites without delay and avoid the risk of surgical complications."
