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feasibility), but by how high the chances are of obtaining a DFS of at least 6-12
months. There are a series of concepts and data guiding us between what is
technically feasible and what is oncologically sound. First, curability of stage IV
may be as high as 50% in very selected case series, but in unselected cases
curability is extremely low, 1 to 4% in non-dedicated randomized trials. Second,
whenever we “push” for very extensive surgery, the median RFS is < 12 and
sometimes < 6 months. Third the disease might accelerate its course under the
“shower” of wounds–related growth factors. Fourth, toxicity and costs of these
approaches are very high. The contrast between the appeal (and sometimes
Annals of Oncology
strong benefit) of the NED state and the questionable clinical value of this
condition, when short lived, has implications on both clinical practice and the
design of clinical trials. Wrong deviations from the classical palliative systemic
treatment, pursuing miraculous results, but actually promoting clinical
deterioration, are the most common consequences of these approaches in
practice. Very high originality and relevance, but low intrinsic and external
validity of the results are the classical features and limits of the trials designed
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Disclosure: All authors have declared no conflicts of interest.
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