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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

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.

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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.

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Correspondence to Daniel Pietrasz MD.

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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).

Additional information

The AGEO and FRENCH associations supported this study.

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Pietrasz, D., Turrini, O., Vendrely, V. et al. How Does Chemoradiotherapy Following Induction FOLFIRINOX Improve the Results in Resected Borderline or Locally Advanced Pancreatic Adenocarcinoma? An AGEO-FRENCH Multicentric Cohort. Ann Surg Oncol 26, 109–117 (2019). https://doi.org/10.1245/s10434-018-6931-6

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  • DOI: https://doi.org/10.1245/s10434-018-6931-6

Keywords

  • FOLFIRINOX (FLX)
  • Chemoradiotherapy (CRT)
  • Additional CRT
  • Major Pathologic Response
  • Preoperative Chemoradiotherapy