Detecting tumour response and predicting resectability after neoadjuvant therapy for borderline resectable and locally advanced pancreatic cancer

Barreto, Savio George; Loveday, Benjamin; Windsor, John A.; Pandanaboyana, Sanjay

doi:10.1111/ans.14764

Cited by 43 publications

(41 citation statements)

References 57 publications

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“…The results showed that the change in the tumor size after NAT on EUS was a sensitive marker for tumor response evaluation, and tumor size reduction ≥ 47% was an independent prognostic factor for OS in these patients. A systematic review from Barreto et al [ 34 ] compared the accuracy of imaging modalities to predict resectability and R0 resection for borderline or locally advanced PDAC after NAT. They showed that effective imaging evaluation allowed prediction of tumor resectability.…”

Section: Response Assessment Of Pdac After Natmentioning

confidence: 99%

“…In a study of 129 patients with borderline PDAC, the authors found that the commonly used response evaluation criteria in solid tumors (RECIST) criteria were not suitable for evaluating tumor response after NAT, because there were few morphological changes in the imaging after treatment[ 37 ]. A systematic review reported that only a small number of patients showed tumor shrinkage after NAT (Figure 2 ), and most patients (53%-80%) had stable disease[ 34 ]. Similar results were reported by a recent study[ 38 ] that showed that the assessment of resectability by MDCT after NAT is relatively insensitive and non-specific to predict R0 resection, because MDCT cannot accurately distinguish between residual tumor and tissue scarring after tumor regression[ 39 ].…”

Section: Response Assessment Of Pdac After Natmentioning

confidence: 99%

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Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma

Zhang¹,

Huang²,

Song³

2021

WJG

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Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy. Despite the development of multimodality treatments, including surgical resection, radiotherapy, and chemotherapy, the long-term prognosis of patients with PDAC remains poor. Recently, the introduction of neoadjuvant treatment (NAT) has made more patients amenable to surgery, increasing the possibility of R0 resection, treatment of occult micro-metastasis, and prolongation of overall survival. Imaging plays a vital role in tumor response evaluation after NAT. However, conventional imaging modalities such as multidetector computed tomography have limited roles in the assessment of tumor resectability after NAT for PDAC because of the similar appearance of tissue fibrosis and tumor infiltration. Perfusion computed tomography, using blood perfusion as a biomarker, provides added value in predicting the histopathologic response of PDAC to NAT by reflecting the changes in tumor matrix and fibrosis content. Other imaging technologies, including diffusion-weighted imaging of magnetic resonance imaging and positron emission tomography, can reveal the tumor response by monitoring the structural changes in tumor cells and functional metabolic changes in tumors after NAT. In addition, with the renewed interest in data acquisition and analysis, texture analysis and radiomics have shown potential for the early evaluation of the response to NAT, thus improving patient stratification to achieve accurate and intensive treatment. In this review, we briefly introduce the application and value of NAT in resectable and unresectable PDAC. We also summarize the role of imaging in evaluating the response to NAT for PDAC, as well as the advantages, limitations, and future development directions of current imaging techniques.

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Section: Response Assessment Of Pdac After Natmentioning

confidence: 99%

Section: Response Assessment Of Pdac After Natmentioning

confidence: 99%

Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma

Zhang¹,

Huang²,

Song³

2021

WJG

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“…The first three of these are defined by the tumour relationship to surrounding vasculature [ 81 ]. The goal of neoadjuvant treatment (NAT) in borderline resectable tumours is to allow downstaging to facilitate resection [ 18 , 82 ], and a number of trials have assessed the role of both chemotherapy and chemoradiotherapy based NAT in upfront resectable disease [ 83 , 84 , 85 ], the theory being that we would identify during treatment, those who are likely to progress rapidly and thus avoid an unnecessary and potentially morbid procedure for these patients [ 15 , 16 , 17 ]. Questions remain about the appropriate use of NAT in terms of what scenarios it should be used, for how long, and if radiotherapy has a role [ 86 , 87 ].…”

Section: The Biomechanical Pdac Microenvironmentmentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma: Relating Biomechanics and Prognosis

MacCurtain

Quirke

Thorpe

et al. 2021

JCM

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Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer and carries a dismal prognosis. Resectable patients are treated predominantly with surgery while borderline resectable patients may receive neoadjuvant treatment (NAT) to downstage their disease prior to possible resection. PDAC tissue is stiffer than healthy pancreas, and tissue stiffness is associated with cancer progression. Another feature of PDAC is increased tissue heterogeneity. We postulate that tumour stiffness and heterogeneity may be used alongside currently employed diagnostics to better predict prognosis and response to treatment. In this review we summarise the biomechanical changes observed in PDAC, explore the factors behind these changes and describe the clinical consequences. We identify methods available for assessing PDAC biomechanics ex vivo and in vivo, outlining the relative merits of each. Finally, we discuss the potential use of radiological imaging for prognostic use.

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“…80% beträgt. Neuere wissenschaftliche Untersuchungen ebenso wie die klinische Erfahrung zeigen, dass andere bildgebende Verfahren als die hier eingesetzten, speziell die Endosonographie aber auch die PET-CT diese Rate deutlich verbessern können, besonders dann, wenn mehrere Verfahren zum Einsatz kommen [4, 5].…”

Section: Transfer In Die Praxis Von Prof Dr Hans-rudolf Raab (Oldenunclassified

Pankreaskarzinom: Internistische und chirurgische Onkologen können gemeinsam mehr erreichen

Raab¹

2020

Kompass Onkol

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Background: One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. Methods: Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. Results: One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). Conclusion: Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. Trial registration: EudraCT: 2009–014476–21 (2013–02–22) and NCT01827553 (2013–04–09).

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Detecting tumour response and predicting resectability after neoadjuvant therapy for borderline resectable and locally advanced pancreatic cancer

Abstract: More than half the patients undergo resection post-NAT for LAPC and BRPC. Stable, or reduction of, tumour disease may predict resectability. Reduction in tumour SUV on PET-CT and decreased tumour stiffness on EUS elastography may be potential markers of NAT response and resectability.

Cited by 43 publications

References 57 publications

Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma

Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma

Pancreatic Ductal Adenocarcinoma: Relating Biomechanics and Prognosis

Pankreaskarzinom: Internistische und chirurgische Onkologen können gemeinsam mehr erreichen

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