PMID- 25755849 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220318 IS - 1948-7894 (Print) IS - 1948-7908 (Electronic) IS - 1948-7908 (Linking) VI - 2 IP - 4 DP - 2013 Dec TI - Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships. PG - 413-425 LID - 10.1007/s13566-013-0115-6 [doi] AB - OBJECTIVE: Neoadjuvant therapy increases rates of margin-negative resection of borderline resectable pancreatic ductal adenocarcinoma (BL-PDAC). Criteria for BL-PDAC resection following neoadjuvant chemotherapy and radiation therapy (NCRT) have not been clearly defined. METHODS: Fifty consecutive patients with BL-PDAC who received NCRT from 2007 to 2012 were identified. Computed tomography (CT) scans pre- and post-treatment were centrally reviewed. RESULTS: Twenty-nine patients (58 %) underwent resection following NCRT, while 21 (42 %) remained unresected. Patients selected for and successfully undergoing resection were more likely to have better performance status and absence of the following features on pre- and post-treatment CT: superior mesenteric vein/portal vein encasement, superior mesenteric artery involvement, tumor involvement of two or more vessels, and questionable/overt metastases (all p <0.05). Tumor volume and degree of tumor-vessel involvement did not significantly change in both groups after NCRT (all p > 0.05). The median overall survival was 22.9 months in resected versus 13.0 months in unresected patients (p < 0.001). Of patients undergoing resection, 93 % were margin-negative, 72 % were node-negative, and 54 % demonstrated moderate pathologic response to NCRT. CONCLUSION: Apparent radiographic extent of vascular involvement does not change significantly after NCRT. Patients without metastatic disease should be chosen for surgical exploration based on adequate performance status and lack of disease progression. FAU - Dholakia, Avani S AU - Dholakia AS AD - Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA. FAU - Hacker-Prietz, Amy AU - Hacker-Prietz A AD - Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA. FAU - Wild, Aaron T AU - Wild AT AD - Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA. FAU - Raman, Siva P AU - Raman SP AD - Department of Radiology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 601 N. Broadway, Baltimore, MD 21231, USA. FAU - Wood, Laura D AU - Wood LD AD - Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 2242, Baltimore, MD 21231, USA. FAU - Huang, Peng AU - Huang P AD - Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 1103, Baltimore, MD 21205, USA. FAU - Laheru, Daniel A AU - Laheru DA AD - Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA. FAU - Zheng, Lei AU - Zheng L AD - Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA. FAU - De Jesus-Acosta, Ana AU - De Jesus-Acosta A AD - Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA. FAU - Le, Dung T AU - Le DT AD - Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21287, USA. FAU - Schulick, Richard AU - Schulick R AD - Department of Surgery, University of Colorado, 12631 E. 17th Avenue, Suite 6117, Aurora, CO 80045, USA. FAU - Edil, Barish AU - Edil B AD - Department of Surgery, University of Colorado, 12631 E. 17th Avenue, Suite 6117, Aurora, CO 80045, USA. FAU - Ellsworth, Susannah AU - Ellsworth S AD - Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA. FAU - Pawlik, Timothy M AU - Pawlik TM AD - Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA. FAU - Iacobuzio-Donahue, Christine A AU - Iacobuzio-Donahue CA AD - Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 2242, Baltimore, MD 21231, USA. FAU - Hruban, Ralph H AU - Hruban RH AD - Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 2242, Baltimore, MD 21231, USA. FAU - Cameron, John L AU - Cameron JL AD - Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA. FAU - Fishman, Elliot K AU - Fishman EK AD - Department of Radiology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 601 N. Broadway, Baltimore, MD 21231, USA. FAU - Wolfgang, Christopher L AU - Wolfgang CL AD - Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA. FAU - Herman, Joseph M AU - Herman JM AD - Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA. LA - eng GR - P30 CA006973/CA/NCI NIH HHS/United States GR - P50 CA062924/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20130922 PL - Germany TA - J Radiat Oncol JT - Journal of radiation oncology JID - 101590774 PMC - PMC4352297 MID - NIHMS667110 OTO - NOTNLM OT - Borderline resectable OT - Chemoradiation OT - Computed tomography OT - Neoadjuvant therapy OT - Pancreatic cancer EDAT- 2013/12/01 00:00 MHDA- 2013/12/01 00:01 PMCR- 2015/03/07 CRDT- 2015/03/11 06:00 PHST- 2013/12/01 00:00 [pubmed] PHST- 2013/12/01 00:01 [medline] PHST- 2015/03/11 06:00 [entrez] PHST- 2015/03/07 00:00 [pmc-release] AID - 10.1007/s13566-013-0115-6 [doi] PST - ppublish SO - J Radiat Oncol. 2013 Dec;2(4):413-425. doi: 10.1007/s13566-013-0115-6. Epub 2013 Sep 22.