Oncology Frontier: The management of asymptomatic primary tumor in patients with unresectable metastatic colorectal cancer remains inconsistent. What kind of treatment approach do you suggest?

　　《肿瘤瞭望》：不能手术切除的转移性结直肠癌患者的无症状原发性肿瘤的治疗仍然存在争议。您推荐什么样的治疗方法？

　　Dr Köhne: The usual approach would have been to resect the primary and then give chemotherapy. That was the conventional approach some years ago. However， we have much more active chemotherapies now， so if the primary is asymptomatic and we have metastases， we would advise giving chemotherapy in order to control the disease and let it shrink. Once we have controlled the disease， we might do an operation on the primary and sometimes also the metastases. The issue is not so controversial anymore. However， it is an individual approach， patient by patient. If the patient has a large primary and small metastasis， we might treat and operate on the primary first and then treat the metastasis. If the primary is small and there are widespread metastases， then it is much better to give chemotherapy first.

　　Köhne博士：几年前的传统方法是切除原发肿瘤然后给予化疗。然而，现在我们推荐更积极的化疗，如果原发肿瘤没有症状，有转移病灶，为了控制病情，并且缩小原发病灶，我们建议给予化疗。一旦控制了病情，我们就有可能通过手术切除原发病灶甚至转移病灶。这一点已经基本达到了共识。然而，必须采取个体化的方案，具体根据患者情况而定。如果患者的原发病灶较大，伴几处小的转移病灶，我们可以首先处理原发病灶，再治疗转移病灶。如果是小的原发病灶伴广泛转移，那么最好首先给予化疗。