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Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2021; 22:702-715. [PMID: 33862000 DOI: 10.1016/s1470-2045(21)00079-6] [Citation(s) in RCA: 423] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment of locally advanced rectal cancer with chemoradiotherapy, surgery, and adjuvant chemotherapy controls local disease, but distant metastases remain common. We aimed to assess whether administering neoadjuvant chemotherapy before preoperative chemoradiotherapy could reduce the risk of distant recurrences. METHODS We did a phase 3, open-label, multicentre, randomised trial at 35 hospitals in France. Eligible patients were adults aged 18-75 years and had newly diagnosed, biopsy-proven, rectal adenocarcinoma staged cT3 or cT4 M0, with a WHO performance status of 0-1. Patients were randomly assigned (1:1) to either the neoadjuvant chemotherapy group or standard-of-care group, using an independent web-based system by minimisation method stratified by centre, extramural extension of the tumour into perirectal fat according to MRI, tumour location, and stage. Investigators and participants were not masked to treatment allocation. The neoadjuvant chemotherapy group received neoadjuvant chemotherapy with FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2 intravenously every 14 days for 6 cycles), chemoradiotherapy (50 Gy during 5 weeks and 800 mg/m2 concurrent oral capecitabine twice daily for 5 days per week), total mesorectal excision, and adjuvant chemotherapy (3 months of modified FOLFOX6 [intravenous oxaliplatin 85 mg/m2 and leucovorin 400 mg/m2, followed by intravenous 400 mg/m2 fluorouracil bolus and then continuous infusion at a dose of 2400 mg/m2 over 46 h every 14 days for six cycles] or capecitabine [1250 mg/m2 orally twice daily on days 1-14 every 21 days]). The standard-of-care group received chemoradiotherapy, total mesorectal excision, and adjuvant chemotherapy (for 6 months). The primary endpoint was disease-free survival assessed in the intention-to-treat population at 3 years. Safety analyses were done on treated patients. This trial was registered with EudraCT (2011-004406-25) and ClinicalTrials.gov (NCT01804790) and is now complete. FINDINGS Between June 5, 2012, and June 26, 2017, 461 patients were randomly assigned to either the neoadjuvant chemotherapy group (n=231) or the standard-of-care group (n=230). At a median follow-up of 46·5 months (IQR 35·4-61·6), 3-year disease-free survival rates were 76% (95% CI 69-81) in the neoadjuvant chemotherapy group and 69% (62-74) in the standard-of-care group (stratified hazard ratio 0·69, 95% CI 0·49-0·97; p=0·034). During neoadjuvant chemotherapy, the most common grade 3-4 adverse events were neutropenia (38 [17%] of 225 patients) and diarrhoea (25 [11%] of 226). During chemoradiotherapy, the most common grade 3-4 adverse event was lymphopenia (59 [28%] of 212 in the neoadjuvant chemotherapy group vs 67 [30%] of 226 patients in the standard-of-care group). During adjuvant chemotherapy, the most common grade 3-4 adverse events were lymphopenia (18 [11%] of 161 in the neoadjuvant chemotherapy group vs 42 [27%] of 155 in the standard-of-care group), neutropenia (nine [6%] of 161 vs 28 [18%] of 155), and peripheral sensory neuropathy (19 [12%] of 162 vs 32 [21%] of 155). Serious adverse events occurred in 63 (27%) of 231 participants in the neoadjuvant chemotherapy group and 50 (22%) of 230 patients in the standard-of-care group (p=0·167), during the whole treatment period. During adjuvant therapy, serious adverse events occurred in 18 (11%) of 163 participants in the neoadjuvant chemotherapy group and 36 (23%) of 158 patients in the standard-of-care group (p=0·0049). Treatment-related deaths occurred in one (<1%) of 226 patients in the neoadjuvant chemotherapy group (sudden death) and two (1%) of 227 patients in the standard-of-care group (one sudden death and one myocardial infarction). INTERPRETATION Intensification of chemotherapy using FOLFIRINOX before preoperative chemoradiotherapy significantly improved outcomes compared with preoperative chemoradiotherapy in patients with cT3 or cT4 M0 rectal cancer. The significantly improved disease-free survival in the neoadjuvant chemotherapy group and the decreased neurotoxicity indicates that the perioperative approach is more efficient and better tolerated than adjuvant chemotherapy. Therefore, the PRODIGE 23 results might change clinical practice. FUNDING Institut National du Cancer, Ligue Nationale Contre le Cancer, and R&D Unicancer.
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Affiliation(s)
- Thierry Conroy
- Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France; APEMAC, Université de Lorraine, Nancy, France.
| | - Jean-François Bosset
- Hôpital Nord Franche-Comté, Montbéliard, France; University Hospital of Besançon, Besançon, France
| | | | - Emmanuel Rio
- Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint-Herblain, France
| | | | | | - Véronique Vendrely
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Xavier Artignan
- Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | | | | | | | - Clotilde Morand
- Centre Hospitalier Départemental, Site de la Roche-sur-Yon, La Roche-sur-Yon, France
| | | | | | | | | | - Eric Rullier
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France
| | - Sophie Gourgou
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Florence Castan
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Christophe Borg
- Hôpital Nord Franche-Comté, Montbéliard, France; University Hospital of Besançon, Besançon, France
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Conroy T, Lamfichekh N, Etienne PL, Rio E, FRANCOIS E, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, De La Fouchardiere C, Juzyna B, Rullier E, Marchal F, Castan F, Borg C. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: Final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4007] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
4007 Background: PRODIGE 23 investigated the role of neoadjuvant mFOLFIRINOX before preoperative (preop) chemoradiation (CRT), with TME-surgery and adjuvant chemotherapy (CT) in resectable locally advanced rectal cancer. Methods: PRODIGE 23 is a phase III multicenter randomized clinical trial. Eligible pts had cT3 or cT4, M0 rectal adenocarcinomas <15 cm from the anal verge, age 18-75 years, and WHO PS ≤1. Randomization was stratified by center, T stage, N status, tumor location, and perirectal fat extramural extension. Primary endpoint was 3-yr disease-free survival (DFS). Main secondary endpoints were ypT0N0 rate, overall survival (OS) and metastasis-free survival (MFS). 460 pts were required to observe 136 events to show a gain in 3-year DFS from 75% to 85% (HR=0.56) with a 2-sided α=0.05 and 90% power. HR and 95% CI were estimated by a stratified Cox proportional hazard model. Arm A pts received preop CRT (50 Gy, 2 Gy/fraction [fr]; 25 fr + capecitabine), surgery, then adjuvant CT for 6 months (mos). Arm B pts received 6 cycles of mFOLFIRINOX (oxaliplatin 85 mg/m², leucovorin 400 mg/m², irinotecan 180 mg/m² D1, and 5-FU 2.4 g/m² over 46 h) every 14 days, followed by the same preop CRT, surgery and 3 mos of adjuvant CT. Adjuvant CT consisted of mFOLFOX6 or capecitabine, depending on the centre’s choice for all pts. Imaging work-up, operative and pathology reports were centrally reviewed. Results: (ITT) Between 6/2012 and 6/2017, 230 and 231 pts were randomly assigned in Arm A/B, respectively by 35 participating centers. Pts characteristics were well balanced. Neoadjuvant mFOLFIRINOX and CRT in both arms were well tolerated. Compliance to CRT and to adjuvant CT was not hampered by neoadjuvant CT. Surgical morbidity did not differ between the 2 arms. The ypT0N0 rate was 11.7 vs 27.5% in Arm A/B (p<0.001). Median follow-up was 46.5 mos. 136 DFS events was reported. 3-yr DFS was significantly increased in arm B (HR 0.69, 95% CI 0.49-0.97, p=0.034): 68.5% (CI: 61.9-74.2) vs 75.7% (CI: 69.4-80.8) in arm A/B. The subgroup analysis showed no evidence of heterogeneity of the effect size of treatment on DFS. 3-yr MFS was also significantly higher in arm B: 71.7 in arm A vs 78.8% (HR 0.64, CI 0.44-0.93, p<0.02) in arm B. 3-yr OS was 87.7 vs 90.8% (HR 0.65, CI 0.40-1.05, p=0.077) in arm A/B, with 54.2% of the pts with recurrence being alive. Conclusions: Neoadjuvant mFOLFIRINOX plus CRT is safe, and significantly increased ypCR rate, DFS and MFS. OS data are not mature. Clinical trial information: NCT01804790 .
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Affiliation(s)
- Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Najib Lamfichekh
- Centre Hospitalier Belfort Monbéliard - Site du Mittan, Montbéliard, France
| | | | - Emmanuel Rio
- ICO-Site René Gauducheau, Saint-Herblain, France
| | - Eric FRANCOIS
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | | | | | | | - Valerie Boige
- Digestive Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Clotilde Morand
- CHD de la Roche-sur-Yon-les Oudairies, La Roche-sur-Yon, France
| | | | | | | | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Florence Castan
- Biometrics Department, Institut du Cancer de Montpellier, Montpellier, France
| | - Christophe Borg
- Department of Medical Oncology, Besancon University Hospital, Besancon, France
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Vuitton L, Jaillet C, Jacquin E, Monnien F, Heberle M, Mihai MI, Lassabe C, Raffoul J, Puyraveau M, Lakkis Z, Lamfichekh N, Picard A, Prétet JL, Mougin C, Valmary-Degano S. Human papillomaviruses in colorectal cancers: A case-control study in western patients. Dig Liver Dis 2017; 49:446-450. [PMID: 27931969 DOI: 10.1016/j.dld.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers. As in other cancer locations, the involvement of human papillomaviruses (HPV) has been suggested but remains highly debated with wide differences among reported prevalence of HPV infection in CRCs. AIM To determine the actual prevalence of high risk HPV16 and 18 in a large case-control study. METHODS CRC specimens were used for analysis of both tumor and distant healthy tissue. As a non-malignant control group, samples from sigmoid diverticulosis resections were studied. Detection of HPV16 and HPV18 DNA was performed using a real time polymerase chain reaction (qPCR). Ten percent of tumor samples were also randomly subjected to a complete HPV genotyping using the INNO-LiPA technique. RESULTS 467 samples were analyzed: 217 tumor samples from 210 CRCs, 210 distant healthy tissue samples, and 40 sigmoid samples. HPV18 DNA was never amplified and HPV16 was amplified only three times in tumor tissues with viral loads under or at the limit of quantification. New extraction from the same tumor blocks for these samples revealed no HPV with qPCR and INNO-Lipa assays. CONCLUSION With adequate procedures and reliable techniques, no HPV was detected in the largest case-control study so far, bringing more evidence on the absence of involvement of HPV in CRCs.
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Affiliation(s)
- Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France; Bourgogne Franche-Comté University, EA3181, Besançon, France.
| | - Carine Jaillet
- Bourgogne Franche-Comté University, EA3181, Besançon, France
| | - Elise Jacquin
- Bourgogne Franche-Comté University, EA3181, Besançon, France; Signalling Department, Babraham Institute, Cambridge, United Kingdom
| | - Franck Monnien
- Department of Pathology, University Hospital of Besançon, Besançon, France
| | - Marine Heberle
- Department of Pathology, University Hospital of Besançon, Besançon, France
| | - Maria I Mihai
- Department of Pathology, University Hospital of Besançon, Besançon, France
| | | | - Johnny Raffoul
- Department of Pathology, Belfort-Montbéliard Hospital, France
| | - Marc Puyraveau
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive and Oncologic Surgery - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Najib Lamfichekh
- Department of Sigestive Surgery, Belfort-Montbéliard Hospital, France
| | - Alain Picard
- Department of Sigestive Surgery, Belfort-Montbéliard Hospital, France
| | - Jean-Luc Prétet
- Bourgogne Franche-Comté University, EA3181, Besançon, France; Department of Pathology, University Hospital of Besançon, Besançon, France
| | - Christiane Mougin
- Bourgogne Franche-Comté University, EA3181, Besançon, France; Department of Pathology, University Hospital of Besançon, Besançon, France
| | - Séverine Valmary-Degano
- Bourgogne Franche-Comté University, EA3181, Besançon, France; Department of Pathology, University Hospital of Besançon, Besançon, France
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Kim S, Paget-Bailly S, Messager M, Nguyen T, Mathieu P, Lamfichekh N, Fein F, Fratté S, Cléau D, Lakkis Z, Jary M, Sakek N, Jacquin M, Foubert A, Bonnetain F, Mariette C, Fiteni F, Borg C. Perioperative docetaxel, cisplatin, and 5-fluorouracil compared to standard chemotherapy for resectable gastroesophageal adenocarcinoma. Eur J Surg Oncol 2017; 43:218-225. [DOI: 10.1016/j.ejso.2016.06.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/20/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022] Open
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Fiteni F, Paget-Bailly S, Messager M, N'Guyen T, Lakkis Z, Mathieu P, Lamfichekh N, Picard A, Benzidane B, Cléau D, Bonnetain F, Borg C, Mariette C, Kim S. Docetaxel, Cisplatin, and 5-Fluorouracil as perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma. Cancer Med 2016; 5:3085-3093. [PMID: 27726290 PMCID: PMC5119963 DOI: 10.1002/cam4.885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 12/25/2022] Open
Abstract
Docetaxel, cisplatin, and 5‐fluorouracil (DCF) significantly improved overall survival in metastatic gastroesophageal adenocarcinoma (GEA). The aim of this study was to assess efficacy of DCF regimen as perioperative chemotherapy compared with surgery alone in patients with resectable GEA. We identified 789 patients who underwent surgery alone and 62 patients who received at least one cycle of DCF regimen consisting of docetaxel (75 mg/m2 on day 1), cisplatin (75 mg/m2 on day 1), and 5‐fluorouracil (750 mg/m2/day on continuous perfusion on days 1 to 5), every 3 weeks. Overall survival was compared using Cox proportional hazards regression model with adjustments for confounding factors provided by two propensity score methods: inverse probability of treatment weighting (IPTW) and matched‐pair analysis. In Cox multivariate analysis weighted by IPTW, DCF group was associated with favorable overall survival (OS) compared with the surgery group (HR = 0.59; 95% CI, 0.45–0.78; P = 0.0003). For the matched‐pair analysis (comparing 41 patients for each group with the same baseline characteristics), median OS was 22 months and 57 months for the surgery group and DCF group, respectively (log‐rank P = 0.0011). In Cox multivariate analysis, DCF group was associated with favorable OS compared with the surgery group (HR = 0.29; 95% IC, 0.14–0.64; P = 0.0019). In the matched‐pair population, major complications (Dindo‐Clavien grade 3–5) arose in six patients (14.63%) in the DCF group and seven patients (17.07%) in the surgery group (P = 1). Perioperative DCF chemotherapy is superior to surgery alone in terms of OS. A randomized phase III trial should compare DCF to standard perioperative regimens.
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Affiliation(s)
- Frédéric Fiteni
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Mathieu Messager
- Lille University Hospital, Department of Digestive Surgery, Lille, France.,FREGAT (French Esophageal and Gastric Tumour) working group, Paris, France
| | - Thierry N'Guyen
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Pierre Mathieu
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Najib Lamfichekh
- Department of Surgery, Nord Franche Comté Hospital, Montbeliard, France
| | - Alain Picard
- Department of Surgery, Nord Franche Comté Hospital, Belfort, France
| | - Bilell Benzidane
- Department of Oncology and Radiotherapy, Nord Franche Comté Hospital, Montbeliard, France
| | - Denis Cléau
- Department of Gastroenterology, Hospital of Vesoul, Vesoul, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,University of Franche-Comté, Besançon, EA 3181, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Unit 1098, INSERM, University of Franche-Comté, Besançon, France.,Clinical Investigational Center, University Hospital of Besançon, CIC-1431, France
| | - Christophe Mariette
- Lille University Hospital, Department of Digestive Surgery, Lille, France.,FREGAT (French Esophageal and Gastric Tumour) working group, Paris, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Unit 1098, INSERM, University of Franche-Comté, Besançon, France.,Clinical Investigational Center, University Hospital of Besançon, CIC-1431, France
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Jary M, Ghiringhelli F, Jacquin M, Fein F, Nguyen T, Cleau D, Nerich V, El Gani M, Mathieu P, Valmary-Degano S, Arnould L, Lassabe C, Lamfichekh N, Fratté S, Paget-Bailly S, Bonnetain F, Borg C, Kim S. Phase II multicentre study of efficacy and feasibility of dose-intensified preoperative weekly cisplatin, epirubicin, and paclitaxel (PET) in resectable gastroesophageal cancer. Cancer Chemother Pharmacol 2014; 74:141-50. [PMID: 24824852 DOI: 10.1007/s00280-014-2482-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/06/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perioperative chemotherapy improves the overall survival of resectable gastroesophageal adenocarcinoma (GEA) patients. However, more than 40 % of the patients are not healthy enough to complete their post-operative chemotherapy, and the progression-free survival rate is lower than 35 % at 5 years. In order to optimise neoadjuvant chemotherapy regimen, a pilot study of weekly dose-intensified cisplatin, epirubicin, and paclitaxel (PET) was conducted. The primary objective was a complete resection (R0) rate. Then, a R0 rate ≤80 % was considered as uninteresting, with an expected R0 rate of 92 %. Secondary objectives were the feasibility, safety, histological response rate (Becker score), and survival (Trial registration: NCT01830270). METHODS Patients with >T1N0M0 GEA were included. Treatment consisted of eight preoperative cycles of weekly PET regimen at 30/50/80 mg/m² of cisplatin, epirubicin, and paclitaxel, respectively. Primary prophylaxis by granulocyte colony-stimulating factor was administered. Surgery was performed 4-6 weeks following the last cycle of chemotherapy. Using Fleming two-step design with a unilateral alpha type one error of 5 % and a statistical power of 80 %, it would be required to include 68 patients. At planned interim analysis for futility, it was required to observe at least 25 of 29 patients with R0 resection to pursue inclusion. At the second step, it was required to observe at least 61 of 68 patients with R0 resection to conclude for promising activity of the dose-intensified chemotherapy. RESULTS Between May 2011 and January 2013, 29 patients were enrolled. Median age was 62 years (range 39-83 years), and seven (24 %) patients presented signet-ring cell histology. Twenty-seven (93 %) patients underwent surgery. Pathological complete responses (Becker score 1a) were observed in four patients, and nearly complete responses (Becker score 1b) for additional three patients. A R0 rate was achieved for 24 of 29 (82.7 %; 95 % CI 64-94 %) patients. No Becker score 1a/1b response was observed among patients with signet-ring cell GEA. Twenty-one (72 %) patients completed all eight cycles, and 86 % received seven or more cycles. Sixteen (56 %) patients experienced grade 3-4 neutropenia, and five patients had febrile neutropenia. Among non-haematological toxicities, mucositis and fatigue were the most frequent ones. The median-delivered relative dose intensity (DI) was 80 % for cisplatin, 75 % for epirubicin, and 79 % for paclitaxel. However, only 45 % of the patients received at least 80 % of the planned median DI for all three drugs. CONCLUSIONS Despite high R0 and pathological response rates, neoadjuvant PET chemotherapy did not meet the primary end-point and failed to show an acceptable relative DI. PET chemotherapy is not recommended in resectable GEA patients.
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Affiliation(s)
- Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
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Demaret S, Lamfichekh N. [One train may hide another...]. ACTA ACUST UNITED AC 2008; 145:174-9. [PMID: 18645562 DOI: 10.1016/s0021-7697(08)73731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S Demaret
- Service de chirurgie digestive, centre hospitalier de Belfort-Montbéliard - Montbéliard
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Lamfichekh N, Dupond AS, Destrumelle N, Runser C, Humbert P, Mantion G. [Surgical treatment of Verneuil's disease (hidradenitis suppurativa): 15 cases]. Ann Dermatol Venereol 2001; 128:127-9. [PMID: 11275587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Verneuil's disease (hidradenitis suppurativa) is a chronic inflammatory, suppurating and fistulizing disease of apocrine sweat gland-bearing skin. The aim of this study was to describe the surgical treatment, conducted in 15 patients suffering from this disease. PATIENTS AND METHODS We retrospectively analyzed 15 observations (9 men, 6 women, mean age 38.6). The mean delay between beginning of the symptoms and diagnosis was 55.5 months. Surgery was conducted at the stage of abscesses, fistulization and keloids in all patients. The first surgical step was wide and deep excision of affected skin and subcutaneous fat. The second step was secondary intention healing, or ideal suture, Z plasty or dorsalis major flap. RESULTS Only four patients had complications: two axillary strictures, one anal margin stenosis and one hypertrophic scarring. Three relapses occurred, treated by excision under local anesthesia. CONCLUSION Surgical treatment seems to be the only definitive treatment of Verneuil's disease.
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Affiliation(s)
- N Lamfichekh
- Service de Chirurgie Générale et Digestive, CHG "André Boulloche", Montbéliard
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