title: Resection of the primary tumour versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases (UICC stage IV): SYNCHRONOUS--a randomised controlled multicentre trial (ISRCTN30964555).
abstract: BACKGROUND
  Currently, it remains unclear, if patients with colon cancer and synchronous unresectable metastases who present without severe symptoms should undergo resection of the primary tumour prior to systemic chemotherapy. Resection of the primary tumour may be associated with significant morbidity and delays the beginning of chemotherapy. However, it may prevent local symptoms and may, moreover, prolong survival as has been demonstrated in patients with metastatic renal cell carcinoma. It is the aim of the present randomised controlled trial to evaluate the efficacy of primary tumour resection prior to systemic chemotherapy to prolong survival in patients with newly diagnosed colon cancer who are not amenable to curative therapy.
  
  
  METHODS
  The SYNCHRONOUS trial is a multicentre, randomised, controlled, superiority trial with a two-group parallel design. Colon cancer patients with synchronous unresectable metastases are eligible for inclusion. Exclusion criteria are primary tumour-related symptoms, inability to tolerate surgery and/or systemic chemotherapy and history of another primary cancer. Resection of the primary tumour as well as systemic chemotherapy is provided according to the standards of the participating institution. The primary endpoint is overall survival that is assessed with a minimum follow-up of 36 months. Furthermore, it is the objective of the trial to assess the safety of both treatment strategies as well as quality of life.
  
  
  CONCLUSIONS
  The SYNCHRONOUS trial is a multicentre, randomised, controlled trial to assess the efficacy and safety of primary tumour resection before beginning of systemic chemotherapy in patients with metastatic colon cancer not amenable to curative therapy.
  
  
  BACKGROUND
  ISRCTN30964555.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Florian
authors.initials: F
authors.lastname: Lordick
authors.forename: Christine
authors.initials: C
authors.lastname: Fink
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bork
authors.forename: Annika
authors.initials: A
authors.lastname: Stange
authors.forename: Dirk
authors.initials: D
authors.lastname: Jäger
authors.forename: Steffen P
authors.initials: SP
authors.lastname: Luntz
authors.forename: Stefan
authors.initials: S
authors.lastname: Englert
authors.forename: Inga
authors.initials: I
authors.lastname: Rossion
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Meinhard
authors.initials: M
authors.lastname: Kieser
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods; D003131:Combined Modality Therapy; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011788:Quality of Life; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents