Brent T Xia1, Baojin Fu2, Jiang Wang2, Young Kim1, S Ameen Ahmad1, Vikrom K Dhar1, Nick C Levinsky1, Dennis J Hanseman1, David A Habib1, Gregory C Wilson1, Milton Smith3, Olugbenga O Olowokure4, Jordan Kharofa5, Ali H Al Humaidi1, Kyuran A Choe6, Daniel E Abbott7, Syed A Ahmad1. 1. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio. 2. Department of Pathology, University of Cincinnati, Cincinnati, Ohio. 3. Division of Gastroenterology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio. 4. Division of Medical Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio. 5. Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio. 6. Department of Radiology, University of Cincinnati, Cincinnati, Ohio. 7. Division of Surgical Oncology, Department of Surgery, Univesity of Wisconsin, Madison, Wisconsin.
Abstract
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.
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.
Authors: Giampaolo Perri; Laura Prakash; Huamin Wang; Priya Bhosale; Gauri R Varadhachary; Robert Wolff; David Fogelman; Michael Overman; Shubham Pant; Milind Javle; Eugene Koay; Joseph Herman; Michael Kim; Naruhiko Ikoma; Ching-Wei Tzeng; Jeffrey E Lee; Matthew H G Katz Journal: Ann Surg Date: 2021-04-01 Impact factor: 13.787