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Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy?
Author(s) -
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.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24538
Subject(s) - medicine , malignancy , radiography , chemotherapy , neoadjuvant therapy , progressive disease , complete response , radiology , pancreaticoduodenectomy , response evaluation criteria in solid tumors , radiation therapy , pancreas , pancreatic cancer , surgery , cancer , breast cancer
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.