Cancer du pancréas localement évolué non resécable : chimioradiothérapie d’induction suivie de chimiothérapie par gemcitabine contre chimiothérapie exclusive par gemcitabine : résultats définitifs de l’étude de phase III 2000–2001de la FFCD et de la SFRO

Barhoumi, M.; Mornex, F.; Bonnetain, Franck; Rougier, Philippe; Mariette, C.; Bouché, Olivier; Bosset, J.-F.; Aparicio, Thomas; Mineur, Laurent; Azzedine, A.; Hammel, Pascal; Butel, J.; Stremsdoerfer, N; Maingon, P.; Bedenne, Laurent; Chauffert, Bruno

doi:10.1016/j.canrad.2010.10.001

Cited by 17 publications

(9 citation statements)

References 29 publications

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“…Lack of benefit for RCT can be explained by the low compliance related to acute toxicity. In a recently published phase 3 trial comparing intensive induction chemoradiation followed by gemcitabine to gemcitabine alone, Barhoumi et al reported that only 42% of patients were able to receive 75% of the planned chemoradiation schedule (60 Gy, 2 Gy/fraction and concomitant infusion of 5-fluorouracil and cisplatin) whereas 73% of patients were given 75% of the treatment of gemcitabine alone (1,000 mg/m2 weekly) [3]. Interestingly, the administration of induction chemotherapy before RCT has been shown to be a promising strategy for selected patients with non progressive disease, which may help to define the subset of patients likely to benefit from RCT while sparing those with rapidly progressive disease from potentially toxic radiotherapy [4].…”

Section: Introductionmentioning

confidence: 99%

Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies

Vieillot¹,

Azria²,

Riou³

et al. 2011

Radiat Oncol

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BackgroundTo compare volumetric-modulated arc therapy plans with conventional radiation therapy (3D-CRT) plans in pancreatic and bile duct cancers, especially for bilateral kidney preservation.MethodsA dosimetric analysis was performed in 21 patients who had undergone radiotherapy for pancreatic or bile duct carcinoma at our institution. We compared 4-field 3D-CRT and 2 arcs RapidArc (RA) plans. The treatment plan was designed to deliver a dose of 50.4 Gy to the planning target volume (PTV) based on the gross disease in a 1.8 Gy daily fraction, 5 days a week. Planning objectives were 95% of the PTV receiving 95% of the prescribed dose and no more than 2% of the PTV receiving more than 107%. Dose-volume histograms (DVH) for the target volume and the organs at risk (right and left kidneys, bowel tract, liver and healthy tissue) were compared. Monitor units and delivery treatment time were also reported.ResultsAll plans achieved objectives, with 95% of the PTV receiving ≥ 95% of the dose (D95% for 3D-CRT = 48.9 Gy and for RA = 48.6 Gy). RapidArc was shown to be superior to 3D-CRT in terms of organ at risk sparing except for contralateral kidney: for bowel tract, the mean dose was reduced by RA compared to 3D-CRT (16.7 vs 20.8 Gy, p = 0.0001). Similar result was observed for homolateral kidney (mean dose of 4.7 Gy for RA vs 12.6 Gy for 3D-CRT, p < 0.0001), but 3D-CRT significantly reduced controlateral kidney dose with a mean dose of 1.8 Gy vs 3.9 Gy, p < 0.0007. Compared to 3D-CRT, mean MUs for each fraction was significantly increased with RapidArc: 207 vs 589, (p < 0.0001) but the treatment time was not significantly different (2 and 2.66 minutes, p = ns).ConclusionRapidArc allows significant dose reduction, in particular for homolateral kidney and bowel, while maintaining target coverage. This would have a promising impact on reducing toxicities.

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Section: Introductionmentioning

confidence: 99%

Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies

Vieillot¹,

Azria²,

Riou³

et al. 2011

Radiat Oncol

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“…In our case, the patient was young with a good performance status, most likely to tolerate and benefit from this aggressive treatment, which was generally well tolerated in literature [9]. Recently, a phase III trial underline the controversial role of radiochemotherapy demonstrating that association of chemoradiation with systemic chemotherapy was more toxic and less effective than gemcitabine alone [10]. Recent series described good results with a combined FOLFIRINOX and radiochemotherapy.…”

Section: Discussionmentioning

confidence: 78%

Complete radiological response of an initially locally advanced unresectable pancreatic cancer to chemoradiotherapy using FOLFIRINOX regimen: Report of a case

Turner

Sandri

Boucher

et al. 2015

Clinics and Research in Hepatology and Gastroenterology

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“…High rates of distant failure imply that using more effective systemic chemotherapy in a CCRT regimen could improve treatment outcomes. FFCD-SFRO in 2001 reported improved survival rates by treating locally advanced pancreatic cancer with gemcitabine alone [21]. However, Crane et al [22] compared the toxicity of CCRT with gemcitabine to 5-FU and demonstrated significantly higher severe toxicity in gemcitabine group.…”

Section: Discussionmentioning

confidence: 99%

Definitive concurrent chemoradiotherapy in locally advanced pancreatic cancer

Kwak

Lee

et al. 2014

Radiat Oncol J

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PurposeSurvival outcome of locally advanced pancreatic cancer has been poor and little is known about prognostic factors of the disease, especially in locally advanced cases treated with concurrent chemoradiation. This study was to analyze overall survival and prognostic factors of patients treated with concurrent chemoradiotherapy (CCRT) in locally advanced pancreatic cancer.Materials and MethodsMedical records of 34 patients diagnosed with unresectable pancreatic cancer and treated with definitive CCRT, from December 2003 to December 2012, were reviewed. Median prescribed radiation dose was 50.4 Gy (range, 41.4 to 55.8 Gy), once daily, five times per week, 1.8 to 3 Gy per fraction.ResultsWith a mean follow-up of 10 months (range, 0 to 49 months), median overall survival was 9 months. The 1- and 2-year survival rates were 40% and 10%, respectively. Median and mean time to progression were 5 and 7 months, respectively. Prognostic parameters related to overall survival were post-CCRT CA19-9 (p = 0.02), the Eastern Cooperative Oncology Group (ECOG) status (p < 0.01), and radiation dose (p = 0.04) according to univariate analysis. In multivariate analysis, post-CCRT CA19-9 value below 180 U/mL and ECOG status 0 or 1 were statistically significant independent prognostic factors associated with improved overall survival (p < 0.01 and p = 0.02, respectively).ConclusionOverall treatment results in locally advanced pancreatic cancer are relatively poor and few improvements have been accomplished in the past decades. Post-treatment CA19-9 below 180 U/mL and ECOG performance status 0 and 1 were significantly associated with an improved overall survival.

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Cancer du pancréas localement évolué non resécable : chimioradiothérapie d’induction suivie de chimiothérapie par gemcitabine contre chimiothérapie exclusive par gemcitabine : résultats définitifs de l’étude de phase III 2000–2001de la FFCD et de la SFRO

Cited by 17 publications

References 29 publications

Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies

Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies

Complete radiological response of an initially locally advanced unresectable pancreatic cancer to chemoradiotherapy using FOLFIRINOX regimen: Report of a case

Definitive concurrent chemoradiotherapy in locally advanced pancreatic cancer

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