New protocols of chemotherapics regimens have led to chemo-first approach. If in non resectable patients is out of doubt that this is the only useful method to gain patients to resectability, in just resectable patients this approach remains questionable. What do you think about it?
We usually use neoadjuvant chemo for resectable CRLM. Even that there is no statistically significant differences in oncologic outcomes from RCT’s. Neoadjuvant chemo gives us information about the biology of the disease as well as some prognostic insight (looking at response rate) and also serves as a “test of time”.
We investigated your question from a cost-effectiveness point of view. If you are interested please read Eur J Cancer. 2011 Oct;47(15):2291-8. doi: 10.1016/j.ejca.2011.05.014.
http://www.sciencedirect.com/science/article/pii/S0959804911003479
There is concern about the use of chemo-first approach for a single colorectal metastasis. In that case surgery-first appoach is better. Chemo-first approach is better indicated for multiple metastases.
There may be practical pros and cons. If you resect the tumor without any neoadjuvant therapy, you could study the tumor cells and learn about their biologic features enough to make informed decisions for systemic therapy. If you get a PT/MRI fusion scan of the liver and it is truely
I think that the multidiscinary approach is nowadays absolutely necessary. Most of patients affected by colorectal metastasis has a clear benefit from a chemo-first approach, because the impact of chemotherapy on tumor burden strong influencing overall survival was already demonstrated and documented. Do not forget that we speak about a systemic disease, and it´s exactly what we don´t see that is going to kill the patient!
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