Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy?

Journal Article (Journal Article)

BACKGROUND AND OBJECTIVES: In patients with borderline resectable pancreas cancers, clinicians frequently consider radiographic response as the primary driver of whether patients should be offered surgical intervention following neoadjuvant therapy (NT). We sought to determine any correlation between radiographic and pathologic response rates following NT. METHODS: Between 2005 and 2015, 38 patients at a tertiary care referral center underwent NT followed by pancreaticoduodenectomy for borderline resectable pancreas cancer. Radiographic response after the completion of NT and pathologic response after surgery were graded according to RECIST and Evans' criteria, respectively. RESULTS: Preoperatively, 50% of patients underwent chemotherapy alone and 50% underwent chemotherapy and chemoradiation. Radiographically, one patient demonstrated a complete radiologic response, 68.4% (n = 26) of patients had stable disease (SD), 26.3% (n = 10) demonstrated a partial response, and one patient had progressive. Among patients without radiographic response, 77.7% (n = 21) achieved a R0 resection. Of patients with SD on imaging, 26.9% (n = 7) had Evans grade IIB or greater pathologic response. CONCLUSIONS: Our data indicate that approximately one-fourth of patients who did not have a radiologic response had a grade IIB or greater pathologic response. In the absence of metastatic progression, lack of radiographic down-staging following NT should not preclude surgery.

Full Text

Duke Authors

Cited Authors

  • Xia, BT; Fu, B; Wang, J; Kim, Y; Ahmad, SA; Dhar, VK; Levinsky, NC; Hanseman, DJ; Habib, DA; Wilson, GC; Smith, M; Olowokure, OO; Kharofa, J; Al Humaidi, AH; Choe, KA; Abbott, DE; Ahmad, SA

Published Date

  • March 2017

Published In

Volume / Issue

  • 115 / 4

Start / End Page

  • 376 - 383

PubMed ID

  • 28105634

Electronic International Standard Serial Number (EISSN)

  • 1096-9098

Digital Object Identifier (DOI)

  • 10.1002/jso.24538

Language

  • eng

Conference Location

  • United States