Le traitement inversé des métastases colorectales synchrones. Mise à jour et leçons apprises après une étude pilote (S. Blaser, W. Cacheux, C. Toso, L. Rubbia Brandt, F. Ris, N. Buchs, S. Terraz, M. Ronot, Ph. Morel, A Roth, P. Majno : Departments of Oncology, Surgery, Pathology and Radiology, HPB Centre, Geneva)Retrospective analysis of a prospective database of 49 patients treated with an oxaliplatin based chemotherapy and the reverse surgical approach from 1999 to 2014 (S. Blaser, W. Cacheux, C. Toso, L. Rubbia Brandt, F. Ris, N. Buchs, S. Terraz, M. Ronot, Ph. Morel, A Roth, P. Majno : Departments of Oncology, Surgery, Pathology and Radiology, HPB Centre, Geneva)

AbstractResults: There were 26 males and 23 females (male: 53%). The median age was 65 years (range 38-83). OCFL was used in 20 pts and OCFL-B, in 29 pts. The primary tumour was in the rectum (n=23: 46%), distal colon (n=23: 46%) and proximal colon (n=3: 6%). The distribution of the CRLM was bilobar (n=31: 63%), 19 pts had more than 5 LM (38%) and 22 pts have at least one LM greater than 5 cm (44%). CEA was >=200 mcg/l in 24% of patients. After completion of neoadjuvant chemotherapy, >= 20% decrease in CEA (biologic response rate) and in greater diameter of the greater LM (radiologic RR) were 93% and 79%, respectively. Grade 3-4 toxicity was observed in 14% of patients. Surgical resection consisted in 40 major (>3 segments) and 16 minor hepatectomies, with 7 two-steps hepatectomies. There was no postoperative mortality. Major complications (Dindo-Clavien score >=2) occurred in 3 cases. The primary tumour could be operated in all patients. Local recurrences were observed in 5 patients so far, all with rectal primary tumour. After a median follow-up of 32.7 months, 3 and 5 year overall survival were 64% and 55%, respectively, with a median progression-free survival of 14.4 months.Conclusion: Intensified pre-operative (OCFL-based) chemotherapy followed by a surgical reverse approach in patients with AS-CRLM was effective, safe, well tolerated and allowed more than half of patients to be alive at 5 years after diagnosis. These results confirm the clinical validity of this original multidisciplinary strategy in the treatment of advanced colorectal cancer.Commentateurs : Daniel JAECK et François FAITOT (Strasbourg)