Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor–vessel relationships View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-12

AUTHORS

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

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. More... »

PAGES

413-425

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s13566-013-0115-6

DOI

http://dx.doi.org/10.1007/s13566-013-0115-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1023607749

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25755849


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