Alexandra Nassar1, Jean Marc Phelip2, Diane Goéré3, Jérôme Loriau4, Claire Gallois5, Pierre Michel6, Christophe Penna1, Julien Taieb5, Antoine Brouquet1, Stéphane Benoist7. 1. Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France. 2. Department of Hepato-Gastroenterology and Digestive Oncology, St Etienne University Hospital, St Etienne, France. 3. Department of Digestive Surgery, Saint Louis Hospital, APHP, Paris, France. 4. Department of Digestive Surgery, St-Joseph Hospital, Paris, France. 5. Department of Gastroenterology, Hôpital Européen Georges-Pompidou, APHP, Paris, France. 6. Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France. 7. Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France. stephane.benoist@aphp.fr.
Abstract
BACKGROUND: To report the current clinical practice of French physicians for metachronous resectable liver metastasis (LM) occurring after a FOLFOX adjuvant chemotherapy for primary cancer. METHODS: Twenty four clinical situations were proposed to a panel of experts via 4 learned societies. Clinical situations varied according time of recurrence (early between 6 and 12 month or > 12 month), extension of LM (limited ≤ 2 or extended > 2 lesions), presence of a neuropathy or not, and of a RAS or BRAF mutation. RESULTS: A total of 157 physicians participated in this study. A consensus was reached in 17 (71%) clinical situations. For an early limited recurrence, whatever presence of neuropathy, the preferred therapeutic approach (45%) was upfront surgery. For an early extended recurrence, whatever presence of neuropathy, there was a consensus (64%) for a preoperative chemotherapy by FOLFIRI + biologic agent. For a late recurrence without neuropathy, there was a consensus (50%) for a preoperative FOLFOX chemotherapy, whatever the extension of LM. For a late recurrence with neuropathy, upfront surgery was chosen (52%) for limited LM, and preoperative chemotherapy by FOLFIRI + biologic agent (73%) for extended LM. No response was influenced by the RAS mutation status. There was a strong consensus for intensified preoperative chemotherapy in all clinical situations for BRAF-mutated LM. CONCLUSIONS: This national survey provides an overview of the practice patterns in the treatment of LM occurring after adjuvant FOLFOX for primary. It could be a basis to establish expert's recommendations for the clinical practice.
BACKGROUND: To report the current clinical practice of French physicians for metachronous resectable liver metastasis (LM) occurring after a FOLFOX adjuvant chemotherapy for primary cancer. METHODS: Twenty four clinical situations were proposed to a panel of experts via 4 learned societies. Clinical situations varied according time of recurrence (early between 6 and 12 month or > 12 month), extension of LM (limited ≤ 2 or extended > 2 lesions), presence of a neuropathy or not, and of a RAS or BRAF mutation. RESULTS: A total of 157 physicians participated in this study. A consensus was reached in 17 (71%) clinical situations. For an early limited recurrence, whatever presence of neuropathy, the preferred therapeutic approach (45%) was upfront surgery. For an early extended recurrence, whatever presence of neuropathy, there was a consensus (64%) for a preoperative chemotherapy by FOLFIRI + biologic agent. For a late recurrence without neuropathy, there was a consensus (50%) for a preoperative FOLFOX chemotherapy, whatever the extension of LM. For a late recurrence with neuropathy, upfront surgery was chosen (52%) for limited LM, and preoperative chemotherapy by FOLFIRI + biologic agent (73%) for extended LM. No response was influenced by the RAS mutation status. There was a strong consensus for intensified preoperative chemotherapy in all clinical situations for BRAF-mutated LM. CONCLUSIONS: This national survey provides an overview of the practice patterns in the treatment of LM occurring after adjuvant FOLFOX for primary. It could be a basis to establish expert's recommendations for the clinical practice.
Authors: An-Jin Shie; You-Yu Dai; Ming-Xing Shen; Li Tian; Ming Yang; Wen-Wei Luo; Yenchun Jim Wu; Zhao-Hui Su Journal: Int J Environ Res Public Health Date: 2022-07-11 Impact factor: 4.614