Have We Gone Too Far with Oligometastatic Therapy in Colorectal Cancer?

In patients with low-volume metastatic colorectal cancer, systemic therapy and definitive local treatments improve survival over systemic therapy alone and can be curative in some patients, particularly those with liver metastases. However, data on local debulking therapy in patients with multifocal metastatic colorectal cancer are limited.

In the industry-supported ORCHESTRA trial, nearly 400 patients with multiorgan metastatic colorectal cancer who had disease control after three to four cycles of systemic therapy were randomized to chemotherapy alone or to tumor debulking (via surgery and ablative therapies) plus chemotherapy. Patients were eligible if at least 80% debulking was feasible; at baseline, 47% had five to ten metastases…