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How Does Chemoradiotherapy Following Induction FOLFIRINOX Improve the Results in Resected Borderline or Locally Advanced Pancreatic Adenocarcinoma? An AGEO-FRENCH Multicentric Cohort

  • Daniel Pietrasz
  • Olivier Turrini
  • Véronique Vendrely
  • Jean-Marc Simon
  • Olivia Hentic
  • Romain Coriat
  • Fabienne Portales
  • Bertrand Le Roy
  • Julien Taieb
  • Nicolas Regenet
  • Diane Goere
  • Pascal Artru
  • Jean-Christophe Vaillant
  • Florence Huguet
  • Christophe Laurent
  • Alain Sauvanet
  • Jean-Robert Delpero
  • Jean Baptiste Bachet
  • Antonio Sa Cunha
Pancreatic Tumors
  • 79 Downloads

Abstract

Background

Patients with borderline (BR) or locally advanced (LA) pancreatic adenocarcinoma (PAC) are often treated with induction FOLFIRINOX (FLX). However, the role of additional preoperative chemoradiotherapy (CRT) is controversial. The aim of this study is to evaluate its impact in patients who underwent resection after induction FLX.

Patients and Methods

Retrospective analysis of prospective consecutive surgical BR or LA PAC patients after induction FLX in 23 French centers between November 2010 and December 2015, treated with or without preoperative additional CRT (FLX vs FLX + CRT groups).

Results

Two hundred three patients were included (106 BR, 97 LA PAC). Median number of FLX cycles was 6 (range 1–30); 50% (n = 102) of patients received additional CRT. Median duration between diagnosis and surgery was 5.4 and 8.7 months (P = 0.001) in the FLX and FLX + CRT group, respectively. The 90-day mortality, major complications, and pancreatic fistula rates were 4.4%, 17.7%, and 5.4%, respectively. After 45.1 months follow-up, overall survival (OS) and disease-free survival were 45.4 months and 16.2 months, respectively. Patients with additional CRT had higher R0 resection rate (89.2% vs 76.3%; P = 0.017), ypN0 rate (76.2% vs 48.5%; P < 0.001), and higher rate of pathologic major response (33.3% vs 12.9%; P = 0.001). In the FLX + CRT group, patients had lower rate of locoregional relapse (28.3% vs 50.7%; P = 0.004). Patients with additional CRT had longer OS than those receiving FLX alone (57.8 vs 35.5 months; P = 0.007).

Conclusions

Pathological results and survival data argue for interest in additional CRT. Prospective studies on an intention-to-treat basis are needed to confirm these results.

Notes

Acknowledgment

Daniel Pietrasz, Jean-Baptiste Bachet and Antonio Sa Cunha have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure

The authors declare that they have nothing to disclose.

Clinical Investigators Who Collected Data, Provided, and Cared for Study Patients

Aparicio Thomas, MD, PhD (Avicenne Hospital, Bobigny, France); Berger Anne, MD, PhD (Georges Pompidou European Hospital, Paris, France); Bourdariat Raphaël, MD (Jean Mermoz Hospital, Lyon, France); Blanc Jean-Frédéric (Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France); Chiche Laurence, MD, PhD (Bordeaux South Hospital, Bordeaux, France); Colombo Pierre Emmanuel, MD, PhD (Institut Régional du Cancer ICM, Montpellier, France); Dousset Bertrand, MD, PhD (Cochin Hospital, Paris, France); Drubay Vincent, MD (CHU Lille, Lille, France); Francois Eric, MD (Nice Hospital, Nice, France); Gilabert Marine, MD, PhD (Institut Paoli Calmette, Marseille, France); Hammel Pascal, MD, PhD (Beaujon Hospital, Clichy, France); Lecaille Cédric, MD (Bordeaux North Hospital, Bordeaux, France); Malka David (Gustave Roussy, Villejuif, France); Manfredi Sylvain, MD (Rennes Hospital, Rennes, France); Marthey Lysiane (Kremlin Bicêtre Hospital, Le Kremlin Bicêtre, France); Meunier Bernard, MD, PhD (Rennes Hospital, Rennes, France); Morere François (Paul Brousse Hospital, Villejuif France); Paye François, MD, PhD (Saint-Antoine Hospital, Paris, France); Penna Christophe (Kremlin Bicêtre Hospital, Kremlin Bicêtre, France); Pezet Denis, MD, PhD (CHU Estaing, Clermont Ferrand, France); Piessen Guillaume (CHU Lille, Lille, France); Pittau Gabriella, MD (Paul Brousse Hospiral, Villejuif France); Pointet Anne Laure, MD (Georges Pompidou European Hospital, Paris, France); Schwarz Lilian, MD (Rouen Hospital, Rouen, France); Smith Denis (Bordeaux Saint-André Hospital, Bordeaux, France); Soularue Emilie, MD (Kremlin Bicêtre Hospital, Kremlin Bicêtre, France).

Supplementary material

10434_2018_6931_MOESM1_ESM.docx (73 kb)
Supplementary material 1 (DOCX 73 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Daniel Pietrasz
    • 1
    • 2
  • Olivier Turrini
    • 3
  • Véronique Vendrely
    • 4
  • Jean-Marc Simon
    • 5
  • Olivia Hentic
    • 6
  • Romain Coriat
    • 7
  • Fabienne Portales
    • 8
  • Bertrand Le Roy
    • 9
  • Julien Taieb
    • 10
  • Nicolas Regenet
    • 11
  • Diane Goere
    • 12
  • Pascal Artru
    • 13
  • Jean-Christophe Vaillant
    • 2
  • Florence Huguet
    • 14
  • Christophe Laurent
    • 15
  • Alain Sauvanet
    • 16
  • Jean-Robert Delpero
    • 3
  • Jean Baptiste Bachet
    • 17
  • Antonio Sa Cunha
    • 1
  1. 1.Department of Hepato-Bilio-Pancreatic Surgery, Liver Transplant Center, Paul Brousse HospitalUniversité Paris-Sud, Université Paris-SaclayVillejuifFrance
  2. 2.Department of Digestive and Hepatobiliary Surgery, Pitié-Salpêtrière HospitalSorbonne University, UPMC UniversityParis 06France
  3. 3.Surgical Oncology DepartmentInstitut Paoli CalmetteMarseilleFrance
  4. 4.Departement of Radiotherapy, Hopital Haut LévêqueCHU de BordeauxPessacFrance
  5. 5.Radiation OncologyPitié-Salpêtrière HospitalParisFrance
  6. 6.Pancreato-Gastroenterology DepartmentBeaujon HospitalClichyFrance
  7. 7.Gastroenterology UnitCochin HospitalParisFrance
  8. 8.Institut du Cancer de MontpellierMontpellierFrance
  9. 9.CHU Estaing, Service de Chirurgie DigestiveUniversité Clermont AuvergneClermont-FerrandFrance
  10. 10.Hepatogastroenterology and Digestive Oncology DepartmentGeorges Pompidou HospitalParisFrance
  11. 11.Department of Digestive SurgeryNantes HospitalNantesFrance
  12. 12.Surgical Oncology DepartmentGustave RoussyVillejuifFrance
  13. 13.Department of GastroenterologyHôpital Privé Jean MermozLyonFrance
  14. 14.Department of Radiation OncologyTenon Hospital, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de ParisParisFrance
  15. 15.Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Haut LévêqueCHU de BordeauxPessacFrance
  16. 16.Department of Digestive Surgery and TransplantationBeaujon HospitalClichyFrance
  17. 17.Gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière HospitalSorbonne University, UPMC UniversityParisFrance

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