Clinicians' attitudes towards management of metastatic colorectal adenocarcinoma.

Abstract

Despite being a common problem, the optimal management of in situ primary colorectal carcinomas in patients presenting with unresectable synchronous metastases remains unknown. To date, no prospective randomized studies have been conducted to evaluate the outcomes of different approaches to management. We studied the attitudes of clinicians involved in the management of this group of patients with a view to determine their treatment preferences and assess the feasibility of conducting a randomized study addressing the role of resection of primary colorectal carcinomas in patients presenting with unresectable synchronous metastases.A survey of Australian colorectal surgeons, Australian medical oncologists and Victorian rural general surgeons was conducted.The results indicated that with regard to preferred treatment (i) for patients with asymptomatic sigmoid or caecal primary tumours, surgeons preferred surgery followed by chemotherapy, whereas oncologists preferred chemotherapy alone; (ii) for patients with symptomatic sigmoid or caecal primary tumours, both surgeons and oncologists preferred surgery followed by chemotherapy; and (iii) for patients with metastatic rectal carcinoma, whether asymptomatic or symptomatic, both surgeons and oncologists preferred a multimodality approach to treatment. Clinicians were accepting a broad range of treatment options for patients with both asymptomatic and symptomatic primary colorectal tumours.There is a high level of acceptability among Australian clinicians for both surgical and non-surgical approaches to management of the in situ primary colorectal tumour in patients with unresectable synchronous metastases. Further research is warranted to determine the management strategy that will yield the best outcome for these patients.