Daniel Pietrasz1, Lysiane Marthey2, Mathilde Wagner3, Jean-Frédéric Blanc4, Christophe Laurent5, Olivier Turrini6, Jean Luc Raoul7, Eric Terrebonne8, Olivia Hentic9, Isabelle Trouilloud10, Romain Coriat11, Nicolas Regenet12, Pasquale Innominato13, Julien Taieb10, Antonio Sa Cunha14, Jean Baptiste Bachet15. 1. Department of Digestive and Hepatobiliary Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France. 2. Hepatogastroenterology Department, Antoine Béclère Hospital, Clamart, France. 3. Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France. 4. Hepato-Gastroenterology Department, Saint-André Hospital, Bordeaux, France. 5. Department of Visceral and Transplant Surgery, Saint-André Hospital, Bordeaux, France. 6. Surgical Oncology Department, Institut Paoli Calmette, Marseille, France. 7. Oncology Department, Institut Paoli Calmette, Marseille, France. 8. Gastroenterology and Digestive Oncology Department, Bordeaux South Hospital, Bordeaux, France. 9. Pancreato-Gastroenterology Department, Beaujon Hospital, Clichy, France. 10. Hepatogastroenterology and Digestive Oncology Department, Georges Pompidou Hospital, Paris, France. 11. Gastroenterology Unit, Cochin Hospital, Paris, France. 12. Department of Digestive Surgery, Nantes Hospital, Nantes, France. 13. Hematology-Oncology Department, Paul Brousse Hospital, Villejuif, France. 14. Liver Transplant Center, Paul Brousse Hospital, Villejuif, France. 15. Gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France. jean-baptiste.bachet@aphp.fr.
Abstract
PURPOSE: In view of increased response rates and survivals in patients with metastatic pancreatic adenocarcinoma (PAC) with FOLFIRINOX, many centers proposed this regimen as induction chemotherapy for borderline (BR) or locally advanced (LA) PAC. The aim of this study was to assess surgical and oncological outcomes of patients who underwent resection after induction FOLFIRINOX therapy. METHODS: We prospectively identified surgical consecutive BR or LA PAC patients after induction FOLFIRINOX in 20 observational French centers between November 2010 and December 2013. Two independent experts retrospectively evaluated initial CT scan for central review. RESULTS: Eighty patients were included, 47 had BR and 33 had LA PAC. Median number of FOLFIRINOX cycles was 6 (range 1-30) and 65 % of patients received chemoradiation. The 30-day-mortality, major complications, and symptomatic pancreatic fistula rates were 2.5, 22.5, and 4 %, respectively. R0 resection was achieved in 84 %. After a median follow-up of 38.2 months since diagnosis, disease-free survival (DFS) was 17.16 months. The overall survival rates at 12 and 24 months were 92 and 81 %, respectively. A 26 % (n = 21) pathologic major response (pMR) rate was reached. In univariate and multivariate analysis, pMR was a prognostic factor for DFS (hazard ratio 0.33; P = 0.01 and hazard ratio 0.38; P = 0.035). CONCLUSIONS: Resection after induction FOLFIRINOX is safe and associated with similar or better outcomes as upfront surgery in patients with PAC. A pMR was observed in 26 % of cases and was prognostic of DFS. This therapeutic design should be investigated in prospective studies.
PURPOSE: In view of increased response rates and survivals in patients with metastatic pancreatic adenocarcinoma (PAC) with FOLFIRINOX, many centers proposed this regimen as induction chemotherapy for borderline (BR) or locally advanced (LA) PAC. The aim of this study was to assess surgical and oncological outcomes of patients who underwent resection after induction FOLFIRINOX therapy. METHODS: We prospectively identified surgical consecutive BR or LA PAC patients after induction FOLFIRINOX in 20 observational French centers between November 2010 and December 2013. Two independent experts retrospectively evaluated initial CT scan for central review. RESULTS: Eighty patients were included, 47 had BR and 33 had LA PAC. Median number of FOLFIRINOX cycles was 6 (range 1-30) and 65 % of patients received chemoradiation. The 30-day-mortality, major complications, and symptomatic pancreatic fistula rates were 2.5, 22.5, and 4 %, respectively. R0 resection was achieved in 84 %. After a median follow-up of 38.2 months since diagnosis, disease-free survival (DFS) was 17.16 months. The overall survival rates at 12 and 24 months were 92 and 81 %, respectively. A 26 % (n = 21) pathologic major response (pMR) rate was reached. In univariate and multivariate analysis, pMR was a prognostic factor for DFS (hazard ratio 0.33; P = 0.01 and hazard ratio 0.38; P = 0.035). CONCLUSIONS: Resection after induction FOLFIRINOX is safe and associated with similar or better outcomes as upfront surgery in patients with PAC. A pMR was observed in 26 % of cases and was prognostic of DFS. This therapeutic design should be investigated in prospective studies.
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