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How to approach pancreatic cancer after neoadjuvant treatment: assessment of resectability using multidetector CT and tumor markers

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Abstract

Objectives

To investigate clinical and CT factors associated with local resectability in patients with nonmetastatic pancreatic cancers after neoadjuvant chemotherapy ± radiation therapy (CRT).

Methods

This retrospective study included consecutive patients with nonmetastatic pancreatic cancers who underwent neoadjuvant CRT between June 2009 and June 2019. Tumor size, tumor-vascular contact with artery/vein, and local resectability categories (resectable, borderline resectable, or locally advanced) were assessed at baseline and post-CRT CT. Baseline and post-CRT carbohydrate antigen (CA) 19-9 levels were also assessed. Clinical or imaging features related to R0 resection were determined using logistic regression analysis.

Results

A total of 179 patients (mean age, 62.4 ± 9.3 years; 92 men) were included. After neoadjuvant CRT, 105 (58.7%) patients received R0 resection, while 74 (41.3%) did not. R0 resection rates were significantly different according to post-CRT CT resectability categories (p < 0.001): 82.8% (48/58), 70.1% (47/67), and 18.5% (10/54) for resectable, borderline resectable, and locally advanced disease, respectively. For post-CRT borderline resectable disease, ≥ 50% decrease in CA 19-9 was significantly associated with R0 resection (odds ratio (OR), 3.160; p = 0.02). For post-CRT locally advanced disease, small post-CRT tumor size ≤ 2 cm (OR, 9.668; p = 0.026) and decreased tumor-arterial contact (OR, 24.213; p = 0.022) were significantly associated with R0 resection.

Conclusion

Post-CRT CT resectability categorization may be useful for the assessment of R0 resectability in patients with pancreatic cancer following neoadjuvant CRT. Additionally, ≥ 50% decrease in CA 19-9 was associated with R0 resection in post-CRT borderline resectable disease, while small post-CRT tumor size and decreased tumor-arterial contact were with locally advanced disease.

Key Points

• R0 resection rates following neoadjuvant chemotherapy ± radiation therapy (CRT) were 82.8%, 70.1%, and 18.5% in resectable, borderline resectable, and locally advanced disease, respectively, at post-CRT CT (p < 0.001).

• For post-CRT borderline resectable disease, ≥ 50% decrease in carbohydrate antigen (CA) 19-9 was significantly associated with R0 resection.

• For post-CRT locally advanced disease, small post-CRT tumor size ≤ 2 cm and decreased tumor-arterial contact were significantly associated with R0 resection.

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Abbreviations

CA 19-9:

Carbohydrate antigen 19-9

CRT:

Chemotherapy ± radiation therapy

NCCN:

National Comprehensive Cancer Network

PDAC:

Pancreatic ductal adenocarcinoma

RECIST:

Response Evaluation Criteria in Solid Tumors

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The authors state that this work has not received any funding.

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Correspondence to Jeong Min Lee.

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The scientific guarantor of this publication is Jeong Min Lee.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

• observational

• performed at one institution

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Jeon, S.K., Lee, J.M., Lee, E.S. et al. How to approach pancreatic cancer after neoadjuvant treatment: assessment of resectability using multidetector CT and tumor markers. Eur Radiol 32, 56–66 (2022). https://doi.org/10.1007/s00330-021-08108-0

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