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. 2013 Dec;2(4):413-425.
doi: 10.1007/s13566-013-0115-6. Epub 2013 Sep 22.

Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships

Avani S Dholakia #  1 , Amy Hacker-Prietz #  1 , Aaron T Wild  1 , Siva P Raman  2 , Laura D Wood  3 , Peng Huang  4 , Daniel A Laheru  5 , Lei Zheng  5 , Ana De Jesus-Acosta  5 , Dung T Le  5 , Richard Schulick  6 , Barish Edil  6 , Susannah Ellsworth  1 , Timothy M Pawlik  7 , Christine A Iacobuzio-Donahue  3 , Ralph H Hruban  3 , John L Cameron  7 , Elliot K Fishman  2 , Christopher L Wolfgang  7 , Joseph M Herman  1
Affiliations

Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships

Avani S Dholakia et al. J Radiat Oncol. 2013 Dec.

Abstract

Objective: Neoadjuvant therapy increases rates of margin-negative resection of borderline resectable pancreatic ductal adenocarcinoma (BL-PDAC). Criteria for BL-PDAC resection following neoadjuvant chemotherapy and radiation therapy (NCRT) have not been clearly defined.

Methods: Fifty consecutive patients with BL-PDAC who received NCRT from 2007 to 2012 were identified. Computed tomography (CT) scans pre- and post-treatment were centrally reviewed.

Results: Twenty-nine patients (58 %) underwent resection following NCRT, while 21 (42 %) remained unresected. Patients selected for and successfully undergoing resection were more likely to have better performance status and absence of the following features on pre- and post-treatment CT: superior mesenteric vein/portal vein encasement, superior mesenteric artery involvement, tumor involvement of two or more vessels, and questionable/overt metastases (all p <0.05). Tumor volume and degree of tumor-vessel involvement did not significantly change in both groups after NCRT (all p > 0.05). The median overall survival was 22.9 months in resected versus 13.0 months in unresected patients (p < 0.001). Of patients undergoing resection, 93 % were margin-negative, 72 % were node-negative, and 54 % demonstrated moderate pathologic response to NCRT.

Conclusion: Apparent radiographic extent of vascular involvement does not change significantly after NCRT. Patients without metastatic disease should be chosen for surgical exploration based on adequate performance status and lack of disease progression.

Keywords: Borderline resectable; Chemoradiation; Computed tomography; Neoadjuvant therapy; Pancreatic cancer.

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Figures

Fig. 1
Fig. 1
Treatment approach and response to neadjuvant therapy for BL-PDAC. Patients received either A upfront radiation or chemoradiation (N = 34) or B chemotherapy followed by chemoradiation (N = 16). Patients were grouped based on radiographic appearance of tumor–vessel relationships and appearance of overt or questionable metastatic disease on post-treatment CT scan. C Plot showing resection events from the date of the last day of radiation treatment (months). BL-PDAC borderline resectable pancreatic ductal adenocarcinoma, MET metastasis, CXT chemotherapy, RT radiation therapy, ECOG Eastern Cooperative Oncology Group
Fig. 2
Fig. 2
Survival data calculated from date of pathologic diagnosis. Patients undergoing surgical resection had significantly longer OS (A), PFS (B), and LPFS (C) compared to unresected patients
See this image and copyright information in PMC

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