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. 2011 Jul;4(4):128-34.

Comparison of 1-, 2-, and 3-Dimensional Tumor Response Assessment After Neoadjuvant GTX-RT in Borderline-Resectable Pancreatic Cancer

Michael D Chuong  1 , Tom J Hayman, Manish R Patel, Mark S Russell, Mokenge P Malafa, Pamela J Hodul, Gregory M Springett, Junsung Choi, Ravi Shridhar, Sarah E Hoffe
Affiliations

Comparison of 1-, 2-, and 3-Dimensional Tumor Response Assessment After Neoadjuvant GTX-RT in Borderline-Resectable Pancreatic Cancer

Michael D Chuong et al. Gastrointest Cancer Res. 2011 Jul.

Abstract

Background: Facilitation of margin-negative resection is the goal of neoadjuvant therapy regimens used in the treatment of borderline-resectable pancreatic cancer patients. Multiple treatment approaches have shown efficacy in this setting, including neoadjuvant GTX (gemcitabine [Gemzar], docetaxel [Taxotere], and capecitabine [Xeloda]) and radiotherapy (RT). Three-dimensional tumor response may be a more accurate method of assessment compared to traditional 1- and 2-dimensional techniques. We compared these 3 methods in a series of patients who underwent neoadjuvant GTX-RT and surgical resection.

Materials and methods: This retrospective review included borderline-resectable pancreatic cancer patients treated with neoadjuvant GTX followed by 5-FU chemoradiotherapy with the intent of downstaging to resectability. Tumor was contoured on computed tomography (CT) scans obtained at the following time points: (A) initial staging, (B) CT simulation, and (C) restaging. These contours were used to determine tumor response according to WHO, RECIST, and volumetric criteria.

Results: Fourteen patients all experienced a measurable decrease in tumor volume following neoadjuvant therapy and were deemed suitable for at least surgical exploration. Radiotherapy was delivered to a median 50 Gy (range, 45-52 Gy) in 1.8-2.0 Gy fractions via 3-D conformal (21%) or IMRT (79%). The median percent volume changes before and after CT simulation were -3.4% and -52.6%, respectively. The overall median percent change was -54.5%. The corresponding absolute volume changes were -0.42 cm(3) (range, 9.12 to -12.47), -5.31 cm(3) (range, 2.06 to -15.93), and -6.72 cm(3) (range, 0.53 to -15.47), respectively. Response according to WHO, RECIST, and volumetric methods was identical with the exception of 1 patient.

Conclusion: This is the first study to quantify volumetric tumor change objectively as a result of neoadjuvant chemoradiotherapy for the treatment of borderline resectable pancreatic cancer. Our data suggest that tumor response to neoadjuvant therapy is essentially equivalent between 1-, 2-, and 3-dimensional assessment methods.

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Figures

Figure 1.
Figure 1.
Typical isodose curves reflecting dose painting in borderline resectable pancreatic patients who underwent IMRT-based chemoradiotherapy after induction GTX chemotherapy.
Figure 2.
Figure 2.
Tumor volume change (cm3) for individual patients at various intervals (A–B, B–C, and A–C) during neoadjuvant chemoradiotherapy.
Figure 3.
Figure 3.
Median percent tumor volume change at intervals A–B, B–C, and A–C.
See this image and copyright information in PMC

References

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