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

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)4265-4273
Number of pages9
JournalEuropean Radiology
Volume28
Issue number10
DOIs
Publication statusPublished - Oct 1 2018

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Pancreatic Neoplasms
Adenocarcinoma
Neoplasms
Sensitivity and Specificity
Therapeutics
Observation
Drug Therapy

Keywords

  • Induction chemotherapy
  • Multidetector computed tomography
  • Neoplasm staging
  • Pancreas ductal carcinoma
  • Pancreatectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer : increase in tumour attenuation on CT correlates with R0 resection. / Marchegiani, Giovanni; Todaro, Valentina; Boninsegna, Enrico; Negrelli, Riccardo; Sureka, Binit; Bonamini, Debora; Salvia, Roberto; Manfredi, Riccardo; Pozzi Mucelli, Roberto; Bassi, Claudio.

In: European Radiology, Vol. 28, No. 10, 01.10.2018, p. 4265-4273.

Research output: Contribution to journalArticle

Marchegiani, G, Todaro, V, Boninsegna, E, Negrelli, R, Sureka, B, Bonamini, D, Salvia, R, Manfredi, R, Pozzi Mucelli, R & Bassi, C 2018, 'Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection', European Radiology, vol. 28, no. 10, pp. 4265-4273. https://doi.org/10.1007/s00330-018-5410-6
Marchegiani, Giovanni ; Todaro, Valentina ; Boninsegna, Enrico ; Negrelli, Riccardo ; Sureka, Binit ; Bonamini, Debora ; Salvia, Roberto ; Manfredi, Riccardo ; Pozzi Mucelli, Roberto ; Bassi, Claudio. / Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer : increase in tumour attenuation on CT correlates with R0 resection. In: European Radiology. 2018 ; Vol. 28, No. 10. pp. 4265-4273.
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title = "Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection",
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 = "Induction chemotherapy, Multidetector computed tomography, Neoplasm staging, Pancreas ductal carcinoma, Pancreatectomy",
author = "Giovanni Marchegiani and Valentina Todaro and Enrico Boninsegna and Riccardo Negrelli and Binit Sureka and Debora Bonamini and Roberto Salvia and Riccardo Manfredi and {Pozzi Mucelli}, Roberto and Claudio Bassi",
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T1 - Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer

T2 - increase in tumour attenuation on CT correlates with R0 resection

AU - Marchegiani, Giovanni

AU - Todaro, Valentina

AU - Boninsegna, Enrico

AU - Negrelli, Riccardo

AU - Sureka, Binit

AU - Bonamini, Debora

AU - Salvia, Roberto

AU - Manfredi, Riccardo

AU - Pozzi Mucelli, Roberto

AU - Bassi, Claudio

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

KW - Induction chemotherapy

KW - Multidetector computed tomography

KW - Neoplasm staging

KW - Pancreas ductal carcinoma

KW - Pancreatectomy

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