title: Bevacizumab-containing chemotherapy is safe in patients with unresectable metastatic colorectal cancer and a synchronous asymptomatic primary tumor.
abstract: OBJECTIVE
  Surgical resection of asymptomatic primary colorectal cancer in patients presenting with synchronous unresectable metastatic disease is controversial. Concerns and controversies remain over combining cytotoxic chemotherapy with bevacizumab in this patient population.
  
  
  METHODS
  We identified medical records of 99 patients with synchronous metastatic primary colorectal cancer who received chemotherapy with bevacizumab as their initial treatment. The incidence of subsequent use of surgery and surgical outcomes were recorded. Patients were also assessed for overall survival.
  
  
  RESULTS
  Patients who received bevacizumab-containing chemotherapy for synchronous metastatic primary colorectal cancer were divided into the non-surgery and surgery groups according to the resection status of their asymptomatic primary tumor. In the non-surgery group, two patients (4.4%) underwent additional surgery, while three patients (5.7%) required surgery for rectovesical fistula in the surgery group. The median overall survival was 17 months for the non-surgery group (95% CI: 10.6-23.3 months) and 23 months for the surgery group (95% CI: 21.3-24.6 months; P = 0.322).
  
  
  CONCLUSIONS
  This study utilizing chemotherapy with bevacizumab did not result in an increased rate of morbidity related to the unresected primary tumor. Survival is not compromised by leaving the primary colon tumor intact.
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Gazi University Faculty of Medicine, Besevler, Ankara 06500, Turkey. caretta06@hotmail.com
authors.forename: Bulent
authors.initials: B
authors.lastname: Cetin
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Kaplan
authors.forename: Veli
authors.initials: V
authors.lastname: Berk
authors.forename: Gulnihal
authors.initials: G
authors.lastname: Tufan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Benekli
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Isikdogan
authors.forename: Metin
authors.initials: M
authors.lastname: Ozkan
authors.forename: Ugur
authors.initials: U
authors.lastname: Coskun
authors.forename: Suleyman
authors.initials: S
authors.lastname: Buyukberber
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069287:Capecitabine; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin