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Poster display session

3624 - Preoperative chemoradiotherapy after induction FOLFIRINOX improve R0 resection margins rate and histological response in patients secondary resected in borderline or locally advanced pancreatic adenocarcinoma.

Date

09 Sep 2017

Session

Poster display session

Presenters

Daniel PIETRASZ

Citation

Annals of Oncology (2017) 28 (suppl_5): v209-v268. 10.1093/annonc/mdx369

Authors

D. PIETRASZ1, O. Turrini2, V. Vendrely3, C. Laurent4, E. Terrebonne5, O. Hentic Dhome6, A. Sauvanet7, J. Simon8, R. Coriat9, F. Portales10, B. Le Roy11, A. Pointet12, L. Marthey13, N. Regenet14, D. Goere15, P. Artru16, J. Vaillant1, J. Delpero2, J. Bachet17, A. Sa Cunha18

Author affiliations

  • 1 Department Of Digestive And Hepato-biliary Surgery, Groupe Hospitalier Pitié Salpetriere, Sorbonne University, UPMC University, 75013 - Paris/FR
  • 2 Oncological Surgery, Institut Paoli Calmette, Marseille/FR
  • 3 Radiotherapy, CHU Bordeaux Hopital St. André, 33000 - Bordeaux/FR
  • 4 Digestive And Endocrine Surgery, CHU Bordeaux, Bordeaux/FR
  • 5 Medical Oncology, CHU Bordeaux, Hopital Haut Leveque, Bordeaux/FR
  • 6 Gastroenterology And Pancreatology, Beaujon University Hospital, 92110 - Clichy/FR
  • 7 Hôpital Beaujon - Université Paris Vii, Service de Chirurgie Hépatobiliaire et Pancréatique - Department of HBP Surgery Pôle des Maladies de l'Appareil Digestif (PMAD), 92118 - Clichy/FR
  • 8 Radiotherapy, Groupe Hospitalier Pitié Salpetriere, Sorbonne University, UPMC University, 75013 - Paris/FR
  • 9 Gastroenterology And Digestive Oncology Department, Hôpital Cochin, Paris Descartes university, 75014 - PARIS/FR
  • 10 Oncologue Digestif, Institut régional du Cancer de Montpellier (ICM), Montpellier/FR
  • 11 General Surgery, CHU Estaing, Clermont Ferrand/FR
  • 12 Department Of Digestive Oncology, Hopital European George Pompidou, 75015 - Paris/FR
  • 13 Gastroenterology And Digestive Oncology Department, CHU de Bicêtre, 91275 - Le Kremlin Bicetre/FR
  • 14 Service De Chirurgie Digestive Et Endocrinienne, CHU Nantes, Nantes - Nantes/FR
  • 15 Digestive Surgery, Gustave Roussy, Villejuif/FR
  • 16 Gastroenterology And Digestive Oncology Department, Hôpital privé Jean Mermoz, 69373 - Lyon/FR
  • 17 Gastroenterology And Digestive Oncology Department, Groupe Hospitalier Pitié Salpetriere, Sorbonne University, UPMC University, 75651 - Paris/FR
  • 18 Unité D'hospitalisation Chirurgie Hépatique, Biliaire Et Pancréatique, Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif/FR
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Resources

Abstract 3624

Background

Previous studies have shown increased survivals in patients (pts) with borderline (BR) or locally advanced (LA) pancreatic adenocarcinoma (PAC) resected after induction FOLFIRINOX (i-FLX). Two-thirds of pts received also chemoradiotherapy (CRT) in most series. The aim of this study was to evaluate the impact of preoperative CRT after i-FLX in pts resected for BR or LA PAC.

Methods

Data of pts who underwent a curative intent resection after i-FLX with or without concomitant fluoropyrimidine- or gemcitabine-based CRT in 23 French centers from AGEO/FRENCH groups were reviewed in this retrospective study.

Results

From November 2010 to December 2015, 203 pts (119 men, median age of 61.7 years, 106 BR and 97 LA) underwent a pancreatic resection after a median number of 6 cycles (1-30) of i-FLX. CRT was administered in 102 pts (50%), 49 (46%) BR and 53 (54%) LA, with 54 Gy (45-59) median of radiation dose. Initial median tumour size was 31.5 mm (10-110), 82.3% located in the pancreatic head. 40% (n = 80) of tumours required vascular resection. Post-operative mortality (D-60) and morbidities (grade 3-4) were 3.4% and 19.7%, respectively. R0 resection was achieved in 83.3% (n = 169) of pts, higher in those receiving CRT (89.2% vs. 76.2%; p = 0.01). The histological complete response (ypT0N0) and major response (ypT0-1N0) rates were 11% (n = 22) and 23% (n = 47) respectively, significantly higher in pts with CRT (16.0% vs. 5.1%; p = 0.009 and 32.0% vs. 13.4%; p = 0.001). After a median follow-up of 34.4 months, recurrence occurred in 118 pts (58.1%) and 76 (37.4%) died. Median DFS and OS were 16.7 [95% CI: 12.7-20.7] and 46.7 months [95% CI: 37.7-55.7] respectively. Pts receiving additional CRT had longer disease free survival (19.0 vs. 13.3 months; p = 0.17) and significantly longer overall survival than those receiving i-FLX alone (62.9 vs. 35.0 months; p = 0.028).

Conclusions

In this retrospective study, preoperative CRT after i-FLX seems to improve R0 resection rates and histological responses in pts resected for BR or LA PAC. Surgery after i-FLX seems to be safe even when combined with CRT. This strategy should be further evaluated in a prospective manner.

Clinical trial identification

Legal entity responsible for the study

Dr. Daniel Pietrasz

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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