Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques

Wang, Zhen J.; Arif-Tiwari, Hina; Zaheer, Atif; Ameli, Sanaz; Bhosale, Priya; Richard, K. G.; Goenka, Ajit H.; Guimares, Alexander R.; Sangster, Guillermo; Soloff, Erik V.; Tamm, Eric P.; Zins, Marc; Kambadakone, Avinash

doi:10.1007/s00261-020-02723-z

Cited by 20 publications

(16 citation statements)

References 85 publications

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“…To date, accurate assessment of response to (neo)adjuvant treatment remains challenging, which is a crucial step in re-staging and determination of resectability [ 26 , 27 ]. Currently, treatment response is monitored with CT-imaging, which is evaluated by radiologists using the internationally standardized RECIST 1.1 criteria [ 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

“…These criteria focus on a percentual change in tumor dimensions (longest diameter), which are used to determine therapy response: a complete response (CR), partial response (PR), progressive disease (PD), or stable disease (SD) [ 28 ]. Although the role of this approach for assessment of response is limited, besides overestimation of tumor size on CT, the change in tumor attenuation is of limited value in the prediction of resectability, due to the inability to differentiate treatment-related necrosis, therapy-induced fibrosis (TIF), and tumor-associated pancreatitis (TAP) from residual vital tumor tissue in the pancreas [ 26 , 30 , 31 ]. Cassinotto et al concluded ce-CT lacks the sensitivity and performance for accurately monitoring treatment response, showing that the diagnostic performance of ce-CT to predict resectability decreased after neoadjuvant treatment (58% vs. 83%) [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Overview and Future Perspectives on Tumor-Targeted Positron Emission Tomography and Fluorescence Imaging of Pancreatic Cancer in the Era of Neoadjuvant Therapy

Dam

Vuijk

Stibbe

et al. 2021

Cancers

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Background: Despite recent advances in the multimodal treatment of pancreatic ductal adenocarcinoma (PDAC), overall survival remains poor with a 5-year cumulative survival of approximately 10%. Neoadjuvant (chemo- and/or radio-) therapy is increasingly incorporated in treatment strategies for patients with (borderline) resectable and locally advanced disease. Neoadjuvant therapy aims to improve radical resection rates by reducing tumor mass and (partial) encasement of important vascular structures, as well as eradicating occult micrometastases. Results from recent multicenter clinical trials evaluating this approach demonstrate prolonged survival and increased complete surgical resection rates (R0). Currently, tumor response to neoadjuvant therapy is monitored using computed tomography (CT) following the RECIST 1.1 criteria. Accurate assessment of neoadjuvant treatment response and tumor resectability is considered a major challenge, as current conventional imaging modalities provide limited accuracy and specificity for discrimination between necrosis, fibrosis, and remaining vital tumor tissue. As a consequence, resections with tumor-positive margins and subsequent early locoregional tumor recurrences are observed in a substantial number of patients following surgical resection with curative intent. Of these patients, up to 80% are diagnosed with recurrent disease after a median disease-free interval of merely 8 months. These numbers underline the urgent need to improve imaging modalities for more accurate assessment of therapy response and subsequent re-staging of disease, thereby aiming to optimize individual patient’s treatment strategy. In cases of curative intent resection, additional intra-operative real-time guidance could aid surgeons during complex procedures and potentially reduce the rate of incomplete resections and early (locoregional) tumor recurrences. In recent years intraoperative imaging in cancer has made a shift towards tumor-specific molecular targeting. Several important molecular targets have been identified that show overexpression in PDAC, for example: CA19.9, CEA, EGFR, VEGFR/VEGF-A, uPA/uPAR, and various integrins. Tumor-targeted PET/CT combined with intraoperative fluorescence imaging, could provide valuable information for tumor detection and staging, therapy response evaluation with re-staging of disease and intraoperative guidance during surgical resection of PDAC. Methods: A literature search in the PubMed database and (inter)national trial registers was conducted, focusing on studies published over the last 15 years. Data and information of eligible articles regarding PET/CT as well as fluorescence imaging in PDAC were reviewed. Areas covered: This review covers the current strategies, obstacles, challenges, and developments in targeted tumor imaging, focusing on the feasibility and value of PET/CT and fluorescence imaging for integration in the work-up and treatment of PDAC. An overview is given of identified targets and their characteristics, as well as the available literature of conducted and ongoing clinical and preclinical trials evaluating PDAC-targeted nuclear and fluorescent tracers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Overview and Future Perspectives on Tumor-Targeted Positron Emission Tomography and Fluorescence Imaging of Pancreatic Cancer in the Era of Neoadjuvant Therapy

Dam

Vuijk

Stibbe

et al. 2021

Cancers

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“…7 Although surgery is the best treatment option for nonmetastatic PDAC, tumors in patients with borderline resectable or locally advanced disease involve critical local vascular systems and are not suitable for surgery unless their tumors respond to neoadjuvant therapy (NAT). 8,9 Through NAT, borderline resectable PDAC can be treated with radical surgery, which helps to improve the surgical resection rate and prognosis of PDAC. 10 Research has shown that patients with borderline resectable PDAC have a resection rate of 60%-68% after NAT.…”

mentioning

confidence: 99%

“…Therefore, the characteristics of PDAC make its efficacy less suitable for evaluation via CT. 19,20 With the development of imaging techniques, multiple methods have been used to evaluate the efficacy of NAT for PDAC. 8,[21][22][23] Magnetic resonance imaging (MRI) can better visualize pancreatic and tumor tissue components, particularly as a reflection of the degree of fibrosis, microvessel density, and tissue hypoxia. Alongside its ability to detect changes in tumor tissue components earlier than CT, it may be more valuable in evaluating NAT for PDAC.…”

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confidence: 99%

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Application of Magnetic Resonance Imaging in Neoadjuvant Treatment of Pancreatic Ductal Adenocarcinoma

Zeng

Wang

et al. 2022

Magnetic Resonance Imaging

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Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignant tumors of the human digestive system. Due to its insidious onset, many patients have already lost the opportunity for radical resection upon tumor diagnosis. In recent years, neoadjuvant treatment for patients with borderline resectable PDAC has been recommended by multiple guidelines to increase the resection rate of radical surgery and improve the postoperative survival. However, further developments are required to accurately assess the tumor response to neoadjuvant therapy and to select the population suitable for such treatment. Reductions in drug toxicity and the number of neoadjuvant cycles are also critical. At present, the clinical evaluation of neoadjuvant treatment is mainly based on several serological and imaging indicators; however, the unique characteristics of PDAC and the insufficient sensitivity and specificity of the markers render this system ineffective. The imaging evaluation system, magnetic resonance imaging (MRI), has its own unique imaging advantages compared with computed tomography (CT) and other imaging examinations. One key advantage is the ability to reflect the changes more rapidly in tumor tissue components, such as the degree of fibrosis, microvessel density, and tissue hypoxia. It can also perform multiparameter quantitative analysis of tumor tissue and changes, attributing to its increasingly important role in imaging evaluation, and potentially the evaluation of neoadjuvant treatment of pancreatic cancer, as several current articles have studied. At the same time, owing to the complexity of MRI and some of its limitations, its wider application is limited. Compared with CT imaging, few relevant studies have been conducted. In this review article, we will investigate and summarize the advantages, limitations, and future development of MRI in the evaluation of neoadjuvant treatment of PDAC. Evidence Level 3 Technical Efficacy Stage 2

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Current status and perspectives of the future of pancreatic surgery: Establishment of evidence by integration of “art” and “science”

Kang

Kim

2021

Annals of Gastroent Surgery

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Pancreatic cancer surgery continues to be associated with a high operative morbidity rate, poor long‐term survival outcomes, and various challenges in obtaining high‐level evidence. Not only is the early postoperative morbidity rate high, but also late morbidity involves lifelong nutritional support for long‐term survivors. Due to poor survival outcomes even after curative surgery, pancreatic surgeons have doubts about the role of surgery as the definitive treatment for pancreatic cancer. Additionally, conducting clinical trials to obtain high‐level evidence in the field of pancreatic surgery is difficult, and the results have only had a moderate impact on clinical practice due to skepticism regarding their quality. Therefore, quality evidence regarding the extent of resection, mode of approach to dissection, reconstruction methods for pancreatico‐enteric anastomosis, determination of resectability, timing of surgery, and the definition of the resection margin is lacking. However, numerous innovative pancreatic surgical procedures have been developed, which may aptly have been called “art” when they were first introduced, regardless of whether they subsequently were supported by scientific evidence. In this review, we provide recent examples of the integration of art and science in the field of pancreatic surgery, which illustrate how the creative ideas of pancreatic surgeons evolved into generally accepted clinical practice. Pancreatic surgeons should be considered “surgical artists,” “surgical scientists,” and “surgical practitioners.” We look forward to more “surgical artists” educating future “surgical artists and scientists” to create a richer “spirit of innovation,” leading to a more beautiful integration of art and science in the field of pancreatic surgery.

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Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques

Cited by 20 publications

References 85 publications

Overview and Future Perspectives on Tumor-Targeted Positron Emission Tomography and Fluorescence Imaging of Pancreatic Cancer in the Era of Neoadjuvant Therapy

Overview and Future Perspectives on Tumor-Targeted Positron Emission Tomography and Fluorescence Imaging of Pancreatic Cancer in the Era of Neoadjuvant Therapy

Application of Magnetic Resonance Imaging in Neoadjuvant Treatment of Pancreatic Ductal Adenocarcinoma

Current status and perspectives of the future of pancreatic surgery: Establishment of evidence by integration of “art” and “science”

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