Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC)

Cindy Neuzillet (1) , Sebastien Gaujoux (2, 3) , Nicolas Williet (4) , Jean-Baptiste Bachet (5) , Lucile Bauguion , Laurianne Colson Durand , Thierry Conroy (6) , Laetitia Dahan (7) , Marine Gilabert (8) , Florence Huguet (9) , Lysiane Marthey (10) , Julie Meilleroux (11) , Louis De Mestier , Bertrand Napoleon (12) , Fabienne Portales (13) , Antonio Sa Cunha (14) , Lilian Schwarz (15, 16) , Julien Taieb (17) , Benoist Chibaudel (18) , Olivier Bouche (19) , Pascal Hammel (20) , Thesaurus Natl Cancerologie Dig , Soc Natl Francaise Gastroenterol , Federation Francophone Cancerolo , Grp Cooperateur Multidisciplinair , Federation Natl Ctr Lutte Contre , Soc Francaise Chirurg Digestive , Soc Francaise d'Endoscopie Diges , Soc Francaise Radiotherapie Oncolo , Assoc Chirurg Hepato-Bilio-Pancrea , Assoc Francaise Chirurg Afc

1 Hôpital Henri Mondor
2 CHU Pitié-Salpêtrière [AP-HP]
3 Chirurgie digestive, hépato-biliaire et endocrinienne [CHU Cochin]
4 Service d'Hépato-gastroentérologie [CHU Saint-Etienne]
5 Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière]
6 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
7 Service d'oncologie digestive et hépato-gastro-entérologie [Hôpital de la Timone - APHM]
8 CRCM - Centre de Recherche en Cancérologie de Marseille
9 CHU Tenon [AP-HP]
10 Hôpital Bicêtre
11 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
12 hopital jean mermoz
13 ICM - UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle
14 Hôpital Paul Brousse
15 Hôpital Charles Nicolle [Rouen]
16 GPMCND - Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques
17 Service d'Hépato-Gastro Entérologie et Oncologie Digestive
18 Service d'Oncologie Médicale [Institut Hospitalier Franco-Britannique]
19 CHU Reims - Centre Hospitalier Universitaire de Reims
20 Hôpital Beaujon

Background: This document is a summary of the French intergroup guidelines regarding the management of pancreatic adenocarcinoma (PA), updated in July 2018. Design: This collaborative work was produced under the auspices of all French medical and surgical societies involved in the management of PA. It is based on the previous guidelines, recent literature review and expert opinions. Recommendations were graded in three categories, according to the level of evidence. Results: Over the last seven years, significant changes in PA management have been implemented in clinical practice. Imaging/staging: diffusion magnetic resonance imaging is useful before surgery to rule out small liver metastases. Surgery: centralization of pancreatic surgery in expert centers is associated with a decreased postoperative mortality. Adjuvant chemotherapy: modified FOLFIRINOX in fit patients, or gemcitabine, or 5-FU, or gemcitabine plus capecitabine, to be discussed on a case-by-case basis. Locally advanced PA: no survival benefit of chemoradiotherapy. Metastatic PA: FOLFIRINOX and gemcitabine plus nab-paclitaxel combination are first-line standards in fit patients; second-line with 5FU/nal-IRI or 5FU/oxaliplatin combination after first-line gemcitabine. Conclusion: Guidelines for management of PA are continuously evolving and need to be regularly updated. This constant progress is made possible through clinical and translational research. However, as each individual case is particular, they cannot substitute to multidisciplinary tumor board discussion. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Domains: Life Sciences [q-bio]

Cindy Neuzillet, Sebastien Gaujoux, Nicolas Williet, Jean-Baptiste Bachet, Lucile Bauguion, et al.. Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). Digestive and Liver Disease, 2018, 50 (12), pp.1257-1271. ⟨10.1016/j.dld.2018.08.008⟩. ⟨hal-02143547⟩