Abstract
BackgroundBorderline Resectable Pancreatic Cancer (BRPC) remains a unique entity that is difficult to categorize due to variance in definitions and the small number of patients. The ultimate goal is to achieve a free resection (R0) after a favorable response to neoadjuvant therapy that is somewhat difficult to assess by current radiological parameters.AimTo evaluate the role of Magnetic Resonance Imaging (MRI) pancreatic protocol, including Diffusion-Weighted Imaging (DWI), in patients with BRPC receiving neoadjuvant therapy, and further compare it to RECIST criteria and outcome.MethodsHistologically confirmed BRPC patients were prospectively included. DWI-MRI was performed pre- and post-therapy. Clinical characteristics with ensuing operability were recorded and correlated to radiological RECIST/apparent diffusion coefficient (ADC) change, preoperative therapy administrated, surgical resection status, and survival.ResultsOut of 30 BRPC cases, only 11 (36.7%) ultimately underwent pancreaticoduodenectomy. Attaining a stationary or stable disease via ADC/RECIST was achieved in the majority of cases (60%/53.3% respectively). Of the 12 patients (40%) who achieved a regression by ADC, 11 underwent surgery with an R0 status. These surgical cases showed variable RECIST responses (PR=5, SD=4, PD=3). Responders by ADC to neoadjuvant therapy were significantly associated to presenting with abdominal pain (p =0.07), a decline in post-therapy CA19-9 (p<0.001), going through surgery (p<0.001), and even achieving better survival (p<0.001 vs. 0.66).ConclusionDWI-MRI ADC picked up patients most likely to undergo a successful operative procedure better than traditional RECIST criteria. An algorithm incorporating novel radiological advances with CA19-9 deserves further assessment in future studies.
Highlights
Renowned for its grim outlook, pancreatic malignancies herald a dismal prognosis, with the surgical option serving as the only potential niche for this grave malignancy [1]
This study aimed to evaluate the role of MRI pancreatic protocol, including Diffusion-Weighted Imaging (DWI) in patients with borderline resectable pancreatic adenocarcinoma after neoadjuvant therapy, to identify responders by MRI with surgical, histopathological, and outcome data
When comparing survival for the surgical and non-surgical patients, 10 deaths were in the inoperable group, and only one died in the surgical series
Summary
Renowned for its grim outlook, pancreatic malignancies herald a dismal prognosis, with the surgical option serving as the only potential niche for this grave malignancy [1]. The emergence of the concept of borderline pancreatic ductal adenocarcinoma (BPDAC) is a small subset of patients that deserves recognition, and many have set out to define this category mainly based on the imaging acquired. The operating theater acts as the real test if these patients may undergo an actual curative resection or not [2]. As radiological diagnostic advances have continued to detect and set the scene for this potentially curative procedure, it remains yet challenging to select those operable cases correctly [6]. Borderline Resectable Pancreatic Cancer (BRPC) remains a unique entity that is difficult to categorize due to variance in definitions and the small number of patients. The ultimate goal is to achieve a free resection (R0) after a favorable response to neoadjuvant therapy that is somewhat difficult to assess by current radiological parameters
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