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Master Thesis

Radiochimiothérapie des cancers du pancréas borderline ou localement avancés : analyse rétrospective d’une cohorte de 89 patients traités au CHU de Bordeaux

Abstract : Purpose : to assess the secondary resection rates and the overall and progression-free survivals of patients with borderline or locally advanced pancreatic cancer treated by concomitant radiochemotherapy. Methods : this retrospective study of a prospective observational cohort included all patients treated from 2010 to 2014 for non-metastatic borderline and locally advanced pancreatic adenocarcinomas. Treatment strategy consisted in chemotherapy followed by radiochemotherapy then surgery for secondary resectable tumors. Response to therapy and surgical resectability were performed using CT-scan after each sequence of treatment. All CT-scan images have been reviewed retrospectively by a radiologist according to the NCCN 2015 classification. Results : eighty-nine patients (male: 48, 53.9%; median-age: 61, range 35-82) were included. Forty-eight patients had borderline tumors and forty-one locally advanced. All patients were treated by chemotherapy, consisting in Folfirinox regimen (oxaliplatin, irinotecan, 5FU) for 80 patients (89.9 %), followed by radiochemotherapy (median dose: 59 Gy, range 45-66 Gy) for 84 patients (94.4%). Forty-two patients (47.2%; 28 borderline and 14 locally advanced tumors at baseline) could benefit surgery resulting in a complete R0 resection in 37 patients (90%). Median overall survival for the entire population was 21.5 months with a median follow-up of 47.1 months. Overall survival and progression-free survival were significantly higher for patients that underwent resection compared to others (49.7 vs 17.4 months (p<0.01) and 27.8 vs 9.3 months (p<0.01), respectively). Thirteen patients had a complete or sub-complete pathological response ypT0-T1N0, associated with a significantly better overall survival (p<0.01). Conclusion: neoadjuvant treatment consisting in folfirinox chemotherapy followed by radiochemotherapy is an efficient strategy for patients with borderline and locally advanced pancreatic cancers, resulting in good rates of secondary complete surgical resection and pathological response.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01587513
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Submitted on : Thursday, September 14, 2017 - 12:08:43 PM
Last modification on : Friday, October 27, 2017 - 1:15:46 AM

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Claudia Pouypoudat. Radiochimiothérapie des cancers du pancréas borderline ou localement avancés : analyse rétrospective d’une cohorte de 89 patients traités au CHU de Bordeaux. Médecine humaine et pathologie. 2017. ⟨dumas-01587513⟩

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