Wagner Mathilde, Antunes Celia, Pietrasz Daniel, Cassinotto Christophe, Zappa Magaly, Sa Cunha Antonio, Lucidarme Oliver, Bachet Jean-Baptiste
UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France.
Department of Radiology, Coimbra University Hospital, Coimbra, Portugal.
Eur Radiol. 2017 Jul;27(7):3104-3116. doi: 10.1007/s00330-016-4632-8. Epub 2016 Nov 28.
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.
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).
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.
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.
• 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.
评估新辅助FOLFIRINOX（5-氟尿嘧啶/亚叶酸钙/伊立替康/奥沙利铂）化疗后，接受二次切除的临界可切除（BR）和局部晚期（LA）胰腺腺癌在计算机断层扫描（CT）上的解剖学变化，以及这些变化预测可切除性和病理反应的准确性。
回顾性纳入36例接受新辅助FOLFIRINOX化疗（±放化疗）后进行二次切除的BR/LA胰腺腺癌患者。两名放射科医生共同回顾基线和术前CT。研究NCCN（美国国立综合癌症网络）分类、最大径、三轴乘积（P3A）和动静脉受累情况，并与病理反应、切除状态及无病生存期（DFS）进行比较。
31例患者实现R0切除，其中仅6例根据NCCN分类显示分期降低。治疗后，最大径和P3A减小（P<0.0001）。R0切除患者的术前最大径和P3A较小（P=0.019/P=0.021）。完全病理反应患者的最大径/P3A变化更大（P=0.011/P=0.016）。动静脉受累程度降低无法预测R0或ypT0N0（P>0.05）。两名（5%）患者出现血管受累进展，导致DFS缩短。
在新辅助FOLFIRINOX方案（±放化疗）治疗后的BR/LA胰腺腺癌中，CT显示肿瘤大小显著减小。然而，CT分期无法预测可切除性和病理反应。
• FOLFIRINOX（±放化疗）后CT显示肿瘤大小显著减小。• FOLFIRINOX（±放化疗）后CT无法准确预测R0切除。• FOLFIRINOX（±放化疗）后CT无法准确预测完全反应。• 即使NCCN分类稳定，BR/LA胰腺腺癌仍可能实现R0切除。
