Stratégie personnalisée et optimisée dans la prise en charge des cancers du rectum métastatiques synchrones résécables : étude comparative mono-centrique

Abstract : Background: One out of three patients has liver metastases when diagnose with rectal cancer. The short-term therapeutic goal is complete resection (R0) of all tumor sites. The importance of prioritizing metastasis surgery ("liver first") has recently been highlighted, particularly in rectal cancer. This strategy could be optimized by carrying out pelvic concomitant irradiation with hepatic management. The sequence would thus be concentrated in time, would limit the period without systemic treatment and would optimize the response from rectal irradiation. The objective of our study is to evaluate the feasibility and oncological quality of the "Liver First Optimized" (LFO) strategy. Methods: From 2008 to 2018, 24 patients were treated according to LFO strategy, 34 according to a standard strategy prioritizing rectal resection (control group). We collected data prospectively and we performed an intent to treat analysis. The objective of the study was to evaluate the rate of complete therapeutic procedure, as well as the R0 resection rate of all sites. An evaluation of the adaptation of the rectal resection depending on the therapeutic response was also performed. Result: The rate of complete oncologic procedure was 87.5% in the LFO group versus 76.5% in the control group (p=0.29), the liver resection rate was higher in the LFO group (p=0.04). The R0 resection rate was equivalent in the two groups (85.7% vs 88.5%, p=0.78). Complications were less frequent after liver surgery and rectal surgery in the LFO group (21.7% vs 46.2% p=0.07, 31.6% vs 44.1% p=0.44). Rectal preservation was performed in 6 patients in the LFO group and 1 patient in the control group (p=0.006). Overall survival was similar between the two groups (p=0.89), including patients with rectal savings (p=0.31). Recurrences occur more frequently in the control group (42.9% vs 80.8% p=0.03). Conclusion: Our study show that the LFO strategy is a feasible, relevant and safe strategy. Organ preservation which concern a quarter of patients, may be associated with a reduction of therapeutic morbidity and improved survival.
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Julien Bonnet. Stratégie personnalisée et optimisée dans la prise en charge des cancers du rectum métastatiques synchrones résécables : étude comparative mono-centrique. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01959871⟩

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