Dominique Elias

Prognostic factors influencing survival from metastatic (stage IV) gastroenteropancreatic well-differentiated endocrine carcinoma

Survival of metastatic gastroenteropancreatic well-differentiated endocrine carcinoma (GEP WDEC) is not well characterized. We evaluated the long-term outcome and prognostic factors for survival in 118 patients with distant metastases from GEP WDEC. Inclusion criteria were 1) pathological review by a single pathologist according to the present WHO criteria, 2) absence of previous therapy apart from surgery, 3) complete morphological evaluation within 3 months including somatostatin receptor scintigraphy, and 4) follow-up at Gustave-Roussy Institute until death or studys end. Clinical, biological marker, and pathological parameters were analyzed in univariate and multivariate statistical models. Survival after the first complete imaging work-up of the metastatic disease was determined using Kaplan-Meier method. Overall, survival for 5 years after the diagnosis of metastatic disease was 54%. In multivariate analysis, age (hazard ratio (HR): 1.05, 95% confidence interval (CI): 1.01-1.08, P = 0.01), the number of liver metastases (HR: 3.4, 95% CI: 1.4-8.3, P = 0.01), tumor slope (HR: 1.1, 95% CI: 1.0-1.1, P = 0.001), and initial surgery (HR: 0.3, 95% CI: 0.1-0.8, P = 0.01) were predictive of survival. Five-year survival was 100%, 91% (95% CI, 51-98%), 62% (95% CI, 37-83%), and 9% (95% CI, 6-32%) when patients had 0, 1, 2, 3 or more poor prognostic features respectively. This study enables the stratification of metastatic GEP WDEC patients into distinct risk groups. These risk categories can be used to tailor therapeutic approaches and also to design and interpret clinical trials.

Selective Hepatic Intra-arterial Chemotherapy

Placement of a hepatic intra-arterial infusion pump (HAIP) provides liver-specific, continuous infusion of chemotherapeutic agents. The chemotherapeutic agents selected for use with the HAIP should exhibit a high degree of first-pass kinetics, to minimize systemic toxicity. Agents used include fluorodeoxyuridine (FUDR), oxaliplatin, cisplatin, 5-fluorouracil, mitomycin C, and Adriamycin.

Traitement intra-artériel des tumeurs hépatiques

Meme a l’epoque des progres des differents traitements systemiques et en particulier des therapies ciblees, il persiste des indications raisonnables au traitement intra-arteriel des tumeurs hepatiques. Ces indications vont meme en augmentant en raison des progres faits dans le domaine de l’evaluation de nouvelles chimiotherapies intra-arterielles en particulier a base d’oxaliplatine, de nouveaux materiels de perfusion intra-arterielle hepatique poses par les radiologues et de nouveaux vecteurs. Deux types de nouveaux vecteurs ont vu le jour. Le premier utilise des microbilles qui peuvent etre chargees avec de la chimiotherapie : adriamycine pour le traitement du carcinome hepatocellulaire ou irinotecan pour le traitement des metastases refractaires a la chimiotherapie systemique. Le second ne comporte pas d’agent cytotoxique mais apporte au niveau de la tumeur de foie, a l’aide d’une microbille de verre ou de resine, un agent irradiant l’Yttrium90 qui va detruire les cellules tumorales. L’ensemble de ces techniques recentes est en cours d’evaluation afin de definir les meilleures indications. A ce jour, ce sont les metastases hepatiques de cancers colorectaux refractaires a la chimiotherapie qui semblent le plus repondre a ces avancees technologiques. Les formes intermediaires de carcinome hepatocellulaire selon la classification de Barcelone et les metastases de tumeurs endocrines restent egalement des indications « classiques » de ces traitements locoregionaux.