Chimioradiothérapie préopératoire des adénocarcinomes du pancréas: Évaluation anatomopathologique de l'efficacité thérapeutique

Purpose: Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Patients and methods: Treatment consisted of concurrent radiotherapy (50Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300mg/m²/day, five days/week, weeks 1-5) and cisplatin (20mg/m²/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. Results: In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A total of 13 of 26 specimens (50%) presented a major pathologic response (≥ 80% of severely degenerative cancer cells), with one complete pathologic response. The local recurrence and two-year survival rates were 4 and 32%, respectively, for the 26 operated patients. Conclusion: Our results suggest that preoperative chemoradiation provides antitumoral effect associated with major histopathological response in 50% of patients and a high R0 resection rate. Evaluation of histopathological response to neoadjuvant chemoradiation may serve as a surrogate marker for treatment efficacy and further research is needed to determine new prognostic and predictive factors of treatment response.