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More effective combination chemotherapy and the use of targeted agents now extend median survival to 2 years or longer in patients with metastatic colorectal cancer. However, the initial treatment strategy for patients with metastatic colon cancer and an intact primary tumor is controversial. Is chemotherapy adequate, or should chemotherapy be preceded by resection of the primary tumor?
Now, investigators for the National Surgical Adjuvant Breast and Bowel Project report the results of a prospective, multicenter, phase II trial in which 86 colon cancer patients (median age, 58; performance status, 0–1) with unresectable metastases and intact but asymptomatic primary tumors were treated with chemotherapy while surgery on the primary tumor was…