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European Radiology

, Volume 28, Issue 10, pp 4265–4273 | Cite as

Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection

  • Giovanni Marchegiani
  • Valentina Todaro
  • Enrico Boninsegna
  • Riccardo Negrelli
  • Binit Sureka
  • Debora Bonamini
  • Roberto Salvia
  • Riccardo Manfredi
  • Roberto Pozzi Mucelli
  • Claudio Bassi
Oncology

Abstract

Objectives

To assess factors associated with radical resection (R0) of pancreatic ductal adenocarcinoma (PDAC) after induction treatment with FOLFIRINOX.

Methods

Patients with either locally advanced (LA) and borderline resectable (BR) PDAC undergoing surgical exploration after FOLFIRINOX were retrospectively enrolled. Two pancreatic radiologists reviewed the CT blinded to the final outcome and assessed chemotherapy response and resectability. Patients were then divided into R0 resected (group A) and not resected/R1 resected (group B), which were compared.

Results

Of 59 patients included, 19 were defined as unresectable (32%), 33 borderline resectable (56%) and 7 resectable (12%) during the blind radiological evaluation after FOLFIRINOX. Once in a surgical setting, 27% were non-resectable, whereas 73% received surgical resection with a 70% R0 rate. Consequent sensitivity and specificity were 86% and 29%. At imaging review, significant decreases in longest tumour dimension were observed in both groups: from 32 mm (95% CI 15–55) to 21 (10–44) in group A and from 34 (18–70) to 26 (7–60) in group B, p < 0.05. However, a significant increase in tumour attenuation in all phases was only observed for R0 resected, from 52 HU (26–75) to 65 (35–92) in arterial phase (p < 0.001) and from 62 (36–96) to 78 (40–120) in the venous (p = 0.001).

Conclusion

After neoadjuvant FOLFIRINOX, CT predicted resectability with acceptable sensitivity but low specificity. The observation of increased tumour attenuation at CT scan after FOLFIRINOX treatment might represent a reliable predictor of R0 resection.

Key Points

• CT drives the assessment of PDAC resectability after FOLFIRINOX

• CT predicts resectability with acceptable sensitivity but low specificity

• Significant increase in tumour attenuation was only observed for R0 resected PDAC

• Tumour attenuation after FOLFIRINOX represents a reliable predictor of R0 resection

Keywords

Pancreas ductal carcinoma Multidetector computed tomography Neoplasm staging Induction chemotherapy Pancreatectomy 

Abbreviations

AHPBA

Americas Hepato-Pancreato-Biliary Association

AJCC

American Joint Committee on Cancer

BR

Borderline resectable

CT

Computed tomography

DWI

Diffusion-weighted imaging

LA

Locally advanced

MR

Magnetic resonance

PDAC

Pancreatic ductal adenocarcinoma

RECIST

Response Evaluation Criteria In Solid Tumours

Notes

Funding

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

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Claudio Bassi, MD.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Giovanni Marchegiani
    • 1
  • Valentina Todaro
    • 1
  • Enrico Boninsegna
    • 2
  • Riccardo Negrelli
    • 2
  • Binit Sureka
    • 3
  • Debora Bonamini
    • 1
  • Roberto Salvia
    • 1
  • Riccardo Manfredi
    • 4
  • Roberto Pozzi Mucelli
    • 2
  • Claudio Bassi
    • 1
  1. 1.Department of General SurgeryVerona University HospitalVeronaItaly
  2. 2.Department of RadiologyVerona University HospitalVeronaItaly
  3. 3.Institute of Liver and Biliary Sciences of New DelhiNew DelhiIndia
  4. 4.Department of Radiology of the Policlinico GemelliCatholic University of RomeRomeItaly

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