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

• Published in: Journal of surgical oncology Vol. 115; no. 4; pp. 376 - 383
• Main Authors: Xia, Brent T., Fu, Baojin, Wang, Jiang, Kim, Young, Ahmad, S. Ameen, Dhar, Vikrom K., Levinsky, Nick C., Hanseman, Dennis J., Habib, David A., Wilson, Gregory C., Smith, Milton, Olowokure, Olugbenga O., Kharofa, Jordan, Al Humaidi, Ali H., Choe, Kyuran A., Abbott, Daniel E., Ahmad, Syed A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15-03-2017
• Subjects: Aged; Albumins - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; borderline resectable pancreatic cancer; CA-19-9 Antigen - blood; Chemoradiotherapy, Adjuvant; Chemotherapy; Chemotherapy, Adjuvant; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Erlotinib Hydrochloride - administration & dosage; Female; Fluorouracil - therapeutic use; Humans; Leucovorin - therapeutic use; Male; Middle Aged; Neoadjuvant Therapy; Organoplatinum Compounds - therapeutic use; Paclitaxel - administration & dosage; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - therapy; Pancreaticoduodenectomy; pathologic response; Patients; radiologic response; Retrospective Studies; Tertiary Care Centers; borderline resectable pancreatic cancer; radiologic response; neoadjuvant therapy; pathologic response
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24538

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.