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Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques

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Abstract

Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States and is projected to be the second by 2030. Systemic combination chemotherapy is considered an essential first-line treatment for the majority of patients with PDA, in both the neoadjuvant and palliative settings. In addition, a number of novel therapies are being tested in clinical trials for patients with advanced PDA. In all cases, accurate and timely assessment of treatment response is critical to guide therapy, reduce drug toxicities and cost from a failing therapy, and aid adaptive clinical trials. Conventional morphological imaging has significant limitations, especially in the context of determining primary tumor response and resectability following neoadjuvant therapies. In this article, we provide an overview of current therapy options for PDA, highlight several morphological imaging findings that may be helpful to reduce over-staging following neoadjuvant therapy, and discuss a number of emerging imaging, and non-imaging, tools that have shown promise in providing a more precise quantification of disease burden and treatment response in PDA.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA

    Zhen J. Wang

  2. Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA

    Hina Arif-Tiwari

  3. The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Atif Zaheer & Sanaz Ameli

  4. Department of Abdominal Imaging, MD Anderson Cancer Center, Houston, TX, USA

    Priya R. Bhosale & Eric P. Tamm

  5. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Richard K. Do

  6. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Ajit H. Goenka

  7. Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA

    Alexander R. Guimares

  8. Department of Radiology, Louisiana State University, Shreveport, LA, USA

    Guillermo P. Sangster

  9. Department of Radiology, University of Washington, Seattle, WA, USA

    Erik V. Soloff

  10. Department of Medical Imaging, Groupe Hospitalier Paris-Saint Joseph, Paris, France

    Marc Zins

  11. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Avinash R. Kambadakone

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Zhen J. Wang: Consultant, General Electric Healthcare; Richard K. Do: Royalties, Elsevier; Erik V. Soloff: Research grant, General Electric; Eric P. Tamm: Research grant, General Electric; Avinash R. Kambadakone: Research grant, Philips Healthcare; Research grant, General Electric Healthcare; other authors declare that they have no conflict of interest.

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Wang, Z.J., Arif-Tiwari, H., Zaheer, A. et al. Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques. Abdom Radiol 45, 4273–4289 (2020). https://doi.org/10.1007/s00261-020-02723-z

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