Chemotherapy and Maximal Tumor Debulking of Multi-organ Colorectal Cancer Metastases

Inclusion Criteria: * Histological or cytological documentation of cancer is required. * Indication for first line palliative systemic treatment for metastatic colorectal cancer (mCRC). * Patients with CRC metastases in (the primary tumor is excluded as metastatic site) * ≥ 2 different organs if at least \>1 extra-hepatic metastases or * ≥ 2 different organs including \>5 hepatic metastases not located to one lobe or * ≥ 2 different organs including either a positive para-aortal lymph nodes or celiac lymph nodes or adrenal metastases or pleural carcinomatosis or peritoneal carcinomatosis * Feasible radical tumor debulking. Incomplete tumor debulking is allowed only if at least 80% of metastases can be treated. * To meet the inclusion criteria a cytological analysis should be performed in case of any uncertainty about the presence of a lesion e.g. a false positive or false negative result on imaging. * Age ≥ 18 years. * WHO performance status 0 - 1. * Life expectancy of at least 12 weeks. * Adequate bone marrow, liver and renal function as assessed by the following laboratory requirements to be conducted within 7 days prior to screening: * Hemoglobin ≥ 5.6 mmol/L; * Absolute neutrophil count (ANC) ≥ 1,500/mm3; * Platelet count ≥ 100\*109/l; * Total bilirubin ≤ 1.5 times the upper limit of normal; * ALT and AST ≤ 2.5 x upper limit of normal (≤ 5 x upper limit of normal for subjects with liver involvement of their cancer); * Albumin \> 30 g/l; * Serum crea…