Locally Advanced Pancreatic Adenocarcinoma: Reassessment of Response with CT after Neoadjuvant Chemotherapy and Radiation Therapy

Abstract

Partial regression of tumor-vessel contact indicates suitability for surgical exploration, irrespective of the degree of decrease in tumor size or the degree of residual vascular involvement.

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

“…The search yielded 649 studies of which 15 published between 2009 and 2017 were included in the final analysis (Fig. ) . These 15 studies included 995 patients with BRPC ( n = 683) and locally advanced ( n = 312) PDAC.…”

“…These 15 studies included 995 patients with BRPC ( n = 683) and locally advanced ( n = 312) PDAC. All the studies originated from single institutions in the USA ( n = 9), France ( n = 3), Korea ( n = 2) and Spain ( n = 1) . Only one study was prospective in design, with the rest being retrospective (cohort or case controlled) studies.…”

Value of apparent diffusion coefficient prior to neoadjuvant therapy is a predictor of histologic response in patients with borderline resectable pancreatic carcinoma

“…The establishment in the method of evaluation of chemo‐responsiveness before neoadjuvant therapy to give individualized treatment is an urgent issue for BRPC patients. The difficulty in using CT to reassess local regional tumor extension after completion of preoperative neoadjuvant therapy in several studies and tumor size evaluation using RECIST on CT imaging was that it revealed no significant association with treatment response or R0 resection. We found similar results in the present study.…”

Response to Preoperative Therapy in Localized Pancreatic Cancer

“…A 2013 study showed diminished performance of CT scan accuracy predicting R0 resectability or unresectability after preoperative therapy with gemcitabine or 5-Flourouracil when compared to patients treated with first-line surgery (58% vs 83% and 52 vs 88%, respectively) (32). A study from the same year, despite being carried out in a small number of selected patients, concluded that neither changes in tumor CT attenuation nor changes in vascular involvement contributed to the prediction of resectability, and its findings were partially confirmed by a later study performed on a larger cohort, showing that only a partial decrease in tumor-vessel contact or even small decrease in tumor size was associated with R0 resection, in contrast to changes in tumor attenuation (33,34).…”