Local treatment of pancreatic cancer metastases: A multicenter French study of the AGEO group

Clémence Breton; Antoine Meyer; David Malka; Margarida Matias; Thierry De Baere; Pascal Hammel; Antonio Sa Cunha; Angelica Lucchese; David Fuks; Romain Coriat; Claire Gallois; Yann Touchefeu; Marianne Maillet; Isabelle Trouilloud; Pierre Rompteaux; Franck Carbonnel; Emilie Soularue

doi:10.1016/j.clinre.2020.101607

Local treatment of pancreatic cancer metastases: A multicenter French study of the AGEO group

Clin Res Hepatol Gastroenterol. 2021 Nov;45(6):101607. doi: 10.1016/j.clinre.2020.101607. Epub 2021 Mar 2.

Authors

Clémence Breton¹, Antoine Meyer², David Malka³, Margarida Matias³, Thierry De Baere⁴, Pascal Hammel⁵, Antonio Sa Cunha⁶, Angelica Lucchese⁶, David Fuks⁷, Romain Coriat⁸, Claire Gallois⁹, Yann Touchefeu¹⁰, Marianne Maillet¹¹, Isabelle Trouilloud¹², Pierre Rompteaux¹³, Franck Carbonnel², Emilie Soularue¹⁴

Affiliations

¹ Department of Gastroenterology, Bicêtre Hospital AP-HP, Paris-Saclay University, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France. Electronic address: clemence.breton@aphp.fr.
² Department of Gastroenterology, Bicêtre Hospital AP-HP, Paris-Saclay University, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
³ Department of Medical Oncology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
⁴ Department of Radiology, Gustave Roussy, Paris-Saclay University, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
⁵ Department of Oncology, Beaujon Hospital AP-HP, Paris University, 100 Boulevard du Général Leclerc, 92110 Clichy, France.
⁶ Department of Digestive Surgery, Hepatobiliary Center of Paul Brousse APHP, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif, France.
⁷ Department of Digestive Surgery, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.
⁸ Department of Gastro-enterology, Cochin Hospital AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
⁹ Department of Hepato-Gastroenterology and Gastrointestinal Oncology, European Georges Pompidou Hospital AP-HP, Paris University, 20 Rue Leblanc, 75015 Paris, France.
¹⁰ Department of Gastroenterology, Nantes University Hospital, 5 Allée de L'île Gloriette, 44000 Nantes, France.
¹¹ Department of Gastroenterology, Saint-Louis Hospital AP-HP, Paris University,1 Avenue Claude Vellefaux, 75010 Paris, France.
¹² Department of Medical Oncology, Saint-Antoine Hospital AP-HP, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France.
¹³ Department of Gastroenterology, Avicenne Hospital AP-HP, Sorbonne University, 125 Rue de Stalingrad, 93000 Bobigny, Paris, France.
¹⁴ Department of Oncology, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.

PMID: 33662776
DOI: 10.1016/j.clinre.2020.101607

Abstract

Objective: This study reports the efficacy and safety of local treatment of metastases of pancreatic ductal adenocarcinoma (PDAC), with a curative intent.

Methods: We retrospectively included patients with histologically proven PDAC, who underwent a local treatment for metastases between January 1, 2000 and December 31, 2017, from 11 French hospitals. Complications of local treatment were reported. Univariate Cox models were performed to identify prognosis factors associated with overall survival (OS) and disease-free survival (DFS).

Results: We included 52 patients treated for 68 metastases; 33 (64%) of whom had metachronous metastases. Metastatic sites treated were: 39 (57%) hepatic, 18 (27%) pulmonary and 11 (16%) others. Metastases treatments were: 45 (66%) surgery, 9 (13%) radiofrequency and 14 (21%) other procedures. The rates of severe complications and mortality were respectively 10% and 4%. The median OS and DFS after local treatment were 36.5 months and 12.7 months, respectively. Prognosis factors associated with a shorter OS were: liver metastases when compared with lung metastases (HR 4.04; 95%CI: 1.18-13.81), N2 status of primary pancreatic tumor when compared to N0-N1 (HR 9.43; 95%CI: 2.44-36.36) and synchronous metastases when compared to metachronous metastases (HR 2.34; 95%CI: 1.05-5.23). N2 status of primary pancreatic tumor was associated with a shorter DFS when compared to N0-N1 (HR 2.82; 95%CI: 1.05-7.58).

Conclusion: In this series of highly selected patients, local treatment of metastases from PDAC is associated with prolonged survival. The rate of severe complications was low. Factors associated with shorter OS were liver metastases, N2 status and synchronous metastases.

Keywords: Curative intent; Local treatment; Metastases; Pancreatic cancer; Radiotherapy; Surgery.

Publication types

Multicenter Study

MeSH terms

Carcinoma, Pancreatic Ductal* / mortality
Carcinoma, Pancreatic Ductal* / pathology
Carcinoma, Pancreatic Ductal* / therapy
France / epidemiology
Humans
Pancreatic Neoplasms* / mortality
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / therapy
Retrospective Studies
Survival Analysis
Treatment Outcome