Chuong Michael D, Hayman Tom J, Patel Manish R, Russell Mark S, Malafa Mokenge P, Hodul Pamela J, Springett Gregory M, Choi Junsung, Shridhar Ravi, Hoffe Sarah E
Division of Gastrointestinal Oncology H. Lee Moffitt Cancer Center & Research Institute Tampa, FL.
Gastrointest Cancer Res. 2011 Jul;4(4):128-34.
Facilitation of margin-negative resection is the goal of neoadjuvant therapy regimens used in the treatment of borderline-resectable pancreatic cancer patients. Multiple treatment approaches have shown efficacy in this setting, including neoadjuvant GTX (gemcitabine [Gemzar], docetaxel [Taxotere], and capecitabine [Xeloda]) and radiotherapy (RT). Three-dimensional tumor response may be a more accurate method of assessment compared to traditional 1- and 2-dimensional techniques. We compared these 3 methods in a series of patients who underwent neoadjuvant GTX-RT and surgical resection.
This retrospective review included borderline-resectable pancreatic cancer patients treated with neoadjuvant GTX followed by 5-FU chemoradiotherapy with the intent of downstaging to resectability. Tumor was contoured on computed tomography (CT) scans obtained at the following time points: (A) initial staging, (B) CT simulation, and (C) restaging. These contours were used to determine tumor response according to WHO, RECIST, and volumetric criteria.
Fourteen patients all experienced a measurable decrease in tumor volume following neoadjuvant therapy and were deemed suitable for at least surgical exploration. Radiotherapy was delivered to a median 50 Gy (range, 45-52 Gy) in 1.8-2.0 Gy fractions via 3-D conformal (21%) or IMRT (79%). The median percent volume changes before and after CT simulation were -3.4% and -52.6%, respectively. The overall median percent change was -54.5%. The corresponding absolute volume changes were -0.42 cm(3) (range, 9.12 to -12.47), -5.31 cm(3) (range, 2.06 to -15.93), and -6.72 cm(3) (range, 0.53 to -15.47), respectively. Response according to WHO, RECIST, and volumetric methods was identical with the exception of 1 patient.
This is the first study to quantify volumetric tumor change objectively as a result of neoadjuvant chemoradiotherapy for the treatment of borderline resectable pancreatic cancer. Our data suggest that tumor response to neoadjuvant therapy is essentially equivalent between 1-, 2-, and 3-dimensional assessment methods.
促进切缘阴性切除是用于治疗可切除边缘性胰腺癌患者的新辅助治疗方案的目标。多种治疗方法在这种情况下已显示出疗效，包括新辅助GTX（吉西他滨[健择]、多西他赛[泰索帝]和卡培他滨[希罗达]）和放射治疗（RT）。与传统的一维和二维技术相比，三维肿瘤反应可能是一种更准确的评估方法。我们在一系列接受新辅助GTX-RT和手术切除的患者中比较了这三种方法。
这项回顾性研究纳入了接受新辅助GTX治疗，随后接受5-氟尿嘧啶放化疗以期降低分期至可切除性的可切除边缘性胰腺癌患者。在以下时间点获得的计算机断层扫描（CT）图像上勾勒肿瘤轮廓：（A）初始分期，（B）CT模拟，以及（C）再次分期。这些轮廓用于根据世界卫生组织（WHO）、实体瘤疗效评价标准（RECIST）和体积标准确定肿瘤反应。
14例患者在新辅助治疗后肿瘤体积均有可测量的减小，并且被认为至少适合手术探查。通过三维适形放疗（21%）或调强放疗（IMRT，79%）以1.8 - 2.0 Gy的分次剂量给予中位剂量50 Gy（范围45 - 52 Gy）的放射治疗。CT模拟前后的中位体积变化百分比分别为-3.4%和-52.6%。总体中位变化百分比为-54.5%。相应的绝对体积变化分别为-0.42 cm³（范围9.12至-12.47）、-5.31 cm³（范围2.06至-15.93）和-6.72 cm³（范围0.53至-15.47）。除1例患者外，根据WHO、RECIST和体积方法得出的反应相同。
这是第一项客观量化新辅助放化疗治疗可切除边缘性胰腺癌导致的肿瘤体积变化的研究。我们的数据表明，在一维、二维和三维评估方法之间，肿瘤对新辅助治疗的反应基本相当。
