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28.11.2016 | Gastrointestinal

CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma

verfasst von: Mathilde Wagner, Celia Antunes, Daniel Pietrasz, Christophe Cassinotto, Magaly Zappa, Antonio Sa Cunha, Oliver Lucidarme, Jean-Baptiste Bachet

Erschienen in: European Radiology | Ausgabe 7/2017

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Abstract

Aim

To assess anatomic changes on computed tomography (CT) after neoadjuvant FOLFIRINOX (5-fluorouracil/leucovorin/irinotecan/oxaliplatin) chemotherapy for secondary resected borderline resectable (BR) and locally advanced (LA) pancreatic adenocarcinoma and their accuracy to predict resectability and pathological response.

Methods

Thirty-six patients with secondary resected BR/LA pancreatic adenocarcinoma after neoadjuvant FOLFIRINOX chemotherapy (± chemoradiotherapy) were retrospectively included. Two radiologists reviewed baseline and pre-surgical CTs in consensus. NCCN (National Comprehensive Cancer Network) classification, largest axis, product of the three axes (P3A), and arterial/venous involvement were studied and compared to pathological response and resection status and to disease-free survival (DFS).

Results

Thirty-one patients had R0 resection, including only six exhibiting a downstaging according to the NCCN classification. After treatment, the largest axis and P3A decreased (P < 0.0001). The pre-surgical largest axis and P3A were smaller in case of R0 resection (P = 0.019/P = 0.021). The largest axis/P3A variations were higher in case of complete pathological response (P = 0.011/P = 0.016). A decrease of the arterial/venous involvement was not able to predict R0 or ypT0N0 (P > 0.05). Progression of the vascular involvement was seen in two (5 %) patients and led to a shorter DFS.

Conclusion

In BR/LA pancreatic adenocarcinoma after the neoadjuvant FOLFIRINOX regimen (± chemoradiotherapy), significant tumour size decreases were observed on CT. However, CT staging was not predictive of resectability and pathological response.

Key Points

• Significant tumour size decreases were observed on CT after FOLFIRINOX (± chemoradiotherapy).

• CT is not able to predict R0 resection accurately after FOLFIRINOX (± chemoradiotherapy).

• CT is not able to predict complete response accurately after FOLFIRINOX (± chemoradiotherapy).

• Even with a stable NCCN classification, BR/LA pancreatic adenocarcinoma could have R0 resection.

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Titel: CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma
verfasst von: Mathilde Wagner
Celia Antunes
Daniel Pietrasz
Christophe Cassinotto
Magaly Zappa
Antonio Sa Cunha
Oliver Lucidarme
Jean-Baptiste Bachet
Publikationsdatum: 28.11.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 7/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4632-8

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CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma

Abstract