Showing papers by "René Adam published in 2004"

Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival.

Abstract: Objective: To evaluate the long-term survival of patients resected for primarily unresectable colorectal liver metastases (CRLM) downstaged by systemic chemotherapy and to use prognostic factors of outcome for a model predictive of survival on a preoperative setting.

Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases?

Abstract: Hepatic resection is the only treatment that currently offers a chance of long-term survival in patients with colorectal metastases. It is associated with 5-year survival rates ranging from 25% to 41%.1–6 Among the prognostic factors affecting the outcome after liver resection, the number of metastases is one of the most commonly reported.2,3,5,7–11 At the time of diagnosis, it is also the major reason of unresectability. When liver resection is feasible, there is general agreement that patients with 4 or more metastatic nodules gain little benefit from liver resection,2,9–11 although some authors have found no effect of the number of lesions on prognosis.4,12 In our practice however, a high number of metastases has never been considered a contraindication to surgery provided that liver resection was potentially curative and that preoperative chemotherapy had been delivered to control or to downstage metastatic disease. In recent years, great improvements in the effectiveness of chemotherapy have been achieved for metastatic colorectal cancer. Response rate observed with 5-fluorouracil (5-FU) and leucovorin have been significantly increased by the combination with oxaliplatin and/or irinotecan and by changes in drug delivery.13–17 These higher response rates have played a key role in improving the resectability of hepatic metastases, allowing 15% to 20% of patients with initially unresectable tumors to be secondarily resected with reported 5-year survival rates of 30% to 40%.18,19 Irrespective of their initial resectability, our attitude has been to manage these patients by a combination of preoperative chemotherapy and surgery with the objective to treat the metastatic disease through a combined systemic and local approach. The rationale of this policy has been recently supported by the better prognosis obtained with neoadjuvant chemotherapy and surgery, as compared with immediate surgery in patients with multinodular colorectal liver metastases.20 No attention was paid in this latter study to the influence of the response to preoperative chemotherapy on the outcome following hepatic resection. The aim of the present study was to evaluate the role of this factor for the outcome of patients having multiple (≥4) metastases who underwent liver resection.

Oxaliplatin plus irinotecan and FU-FOL combination and pharmacokinetic analysis in advanced colorectal cancer patients.

Abstract: This phase I-II trial was designed to assess the effect of irinotecan on oxaliplatin pharmacokinetics and to determine the MDT of both drugs when administered in combination. Treatment was repeated every 2 weeks. Pharmacokinetic studies were performed on cycle 1 and 2 to assess the best sequence and detect any interaction between the two drugs. Thirty-four patients with advanced colorectal cancer were enrolled; 28 of them (82%) had liver involvement. The main toxicities were neutropenia and delayed diarrhea; 5 patients (14%) experienced febrile neutropenia. Dose-limiting toxicity was experienced at levels 1/2/3/4/5 by 4/10, 1/6, 3/6, 3/8, and 3/4 patients, respectively. Fifteen patients responded (2 CR; 13 PR) for an ORR of 44%. No pharmacokinetic interactions between irinotecan and oxaliplatin were detected. The recommended dose for future phase II trials is oxaliplatin 85 mg/m and irinotecan 180 mg/m2 on day 1 combined with 5FU/leucovorin according to the de Gramont regimen at days 2 and 3. Twenty-nine percent of patients underwent secondary hepatectomy with curative intent, and two of them are long-term disease-free survivors. It would appear that the dose and schedule defined by this trial could be proposed as front-line therapy for advanced colorectal carcinoma to establish rapid disease control and to permit patients to proceed to surgery.

Resection after chemotherapy (CT) with irinotecan (CPT) for initially unresectable liver metastasis (LM) from colorectal cancer (CRC)

Abstract: 3692 Background: Surgical resection of LM is the only treatment able to offer long term survival (30–35% at 5 years); however most LM are initially unresectable. Methods: The aim of this retrospect...

Augmentation de la perméabilité à long terme des anastomoses porto-caves par voie transjugulaire (TIPS) chez 218 patients cirrhotiques, grâce à un suivi strict

Abstract: Resume Objectif Mesurer l’impact d’un suivi strict sur la permeabilite a long terme d’une anastomose porto-cave par voie transjugulaire (TIPS). Methodes De novembre 1991 a decembre 2002, 208 patients (152 hommes et 66 femmes) pris en charge pour la mise en place d’un TIPS pour echec de sclerotherapie ou ascite refractaire ont ete inclus. La permeabilite de la prothese a ete controlee sur la piece apres transplantation. La revision du TIPS etait effectuee durant le meme temps que le diagnostic de l’obstruction par angiographie trans-jugulaire. La permeabilite des TIPS a ete classee en 3 categories : la permeabilite primaire (duree de permeabilite constatee jusqu’a n’importe quelle intervention) ; la permeabilite primaire assistee (duree de permeabilite continue avec ou sans intervention percutanee) ; la permeabilite secondaire (duree de permeabilite totale avec ou sans occlusion traitee). Resultats Sur les 218 patients de l’etude, 108 ont eu un recul du TIPS inferieur a 1 an (49,5 %), 29 un recul compris entre 1 et 2 ans (13,5 %), 27 entre 2 et 3 ans (12,5 %), 16 entre 3 et 4 ans (7,5 %), 15 entre 4 et 5 ans (7 %) et 23 de plus de 5 ans (10 %). Le suivi moyen a ete de 24,1 ± 27,2 mois (mediane 13,7). La survie actuarielle de ces patients etait de 81,2 ± 2,9 % a 1 an, 62,9 ± 4,2 % a 3 ans et 52 ± 4,9 % a 5 ans. Trente-quatre patients ont ete perdus de vue (16 %), apres un suivi moyen de 22,9 ± 26,7 mois (mediane 9,7). Tous ces patients avaient un TIPS permeable lors de leur dernier controle. Cent trente-cinq patients (62 %) n’ont jamais eu d’episode d’obstruction du TIPS, avec un suivi moyen de 19,5 ± 26,2 mois (mediane 7,4) ; 83 patients (38 %) ont eu 117 episodes d’obstruction ; 24 deux episodes, 7 trois et 3 plus de trois ; 4 ont eu une thrombose provoquee pour une encephalopathie invalidante avec une contre-indication a une transplantation, dont 2 apres un premier episode de thrombose. Les permeabilites actuarielles primaires, primaire assistee et secondaire etaient, respectivement, de 67,7 ± 3 % et 51,4 ± 3,7 %, de 79,9 p 2,3 % et 69,3 ± 3,4 %, de 94,4 ± 1,8 % et 91 ± 2,6 % a 1 an et 3 ans (p = 0,0001, Log Rank = 65,3). Une analyse univariee a mis en evidence une relation entre la survenue d’un episode d’obstruction precoce ou tardif pour l’âge du patient au moment de la pose du TIPS, le score de Child avant, le gradient preoperatoire et le gradient postoperatoire. En analyse multivariee, aucun de ces elements n’etait significatif. Conclusion Bien que l’utilisation du TIPS dans le traitement de l’hypertension portale suive l’evolution de toute la chirurgie vers des methodes mini invasives, il est important de ne pas le considerer comme une derivation portale chirurgicale ou comme un traitement definitif : la permeabilite a long terme n’est obtenue qu’au prix d’un suivi regulier et de la possibilite d’une intervention rapide de desobstruction.