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Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

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

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Abbreviations

AHPBA:

Americas Hepato-Pancreato-Biliary Association

AJCC:

American Joint Committee on Cancer

BR:

Borderline resectable

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

LA:

Locally advanced

MR:

Magnetic resonance

PDAC:

Pancreatic ductal adenocarcinoma

RECIST:

Response Evaluation Criteria In Solid Tumours

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of General Surgery, Verona University Hospital, Policlinico G. B. Rossi, P.le Scuro 10, 37134, Verona, Italy

    Giovanni Marchegiani, Valentina Todaro, Debora Bonamini, Roberto Salvia & Claudio Bassi

  2. Department of Radiology, Verona University Hospital, Policlinico G. B. Rossi, P.le Scuro 10, 37134, Verona, Italy

    Enrico Boninsegna, Riccardo Negrelli & Roberto Pozzi Mucelli

  3. Institute of Liver and Biliary Sciences of New Delhi, New Delhi, India

    Binit Sureka

  4. Department of Radiology of the Policlinico Gemelli, Catholic University of Rome, Rome, Italy

    Riccardo Manfredi

Authors
  1. Giovanni Marchegiani
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  2. Valentina Todaro
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  3. Enrico Boninsegna
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  4. Riccardo Negrelli
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  5. Binit Sureka
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  6. Debora Bonamini
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  7. Roberto Salvia
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  8. Riccardo Manfredi
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  9. Roberto Pozzi Mucelli
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  10. Claudio Bassi
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Corresponding author

Correspondence to Claudio Bassi.

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Guarantor

The scientific guarantor of this publication is Claudio Bassi, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Giovanni Marchegiani and Valentina Todaro share the first authorship

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Marchegiani, G., Todaro, V., Boninsegna, E. et al. Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection. Eur Radiol 28, 4265–4273 (2018). https://doi.org/10.1007/s00330-018-5410-6

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  • DOI: https://doi.org/10.1007/s00330-018-5410-6

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