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Type:
Educational Exhibit
Keywords:
Tissue characterisation, Neoplasia, Metastases, Diagnostic procedure, Decision analysis, Chemotherapy, PET-CT, MR-Diffusion/Perfusion, CT, Pancreas, Oncology, Abdomen
Authors:
E. Boninsegna1, R. Negrelli1, G. A. Zamboni1, G. Avesani2, R. Manfredi1, R. Pozzi-Mucelli1; 1Verona/IT, 2Bolzano/IT
DOI:
10.1594/ecr2017/C-0634
Background
Pancreatic ductal adenocarcinoma (PDAC) is one of the leading neoplasms of the gastrointestinal tract and the twelfth most common cancer in the world [1].
Due to the lack of effective screening programs,
by 2030 pancreatic cancer is projected to surpass breast,
lung,
and colorectal cancers to become the second leading cause of cancer-related death in the Western World [2].
At present,
surgical resection is the only potentially curative treatment; it is possible in cases which do not show major vessels involvement and distant metastasis [3].
Unfortunately majority of patients affected by PDAC present with metastatic disease and up to 30% cases with locally advanced neoplasm at the time of initial diagnosis [4].
For locally advanced conditions neoadjuvant chemotherapy with or without radiotherapy is the only available option that may allow tumor downstaging and thereafter surgery [5,6].
Several response criteria have been proposed in the past years to assess neoadjuvant treatment response in patients with PDAC.
Unfortunately it is a very desmoplastic neoplasm,
hypo-vascularised and rich in fibrous tissue; so,
it is difficult to distinguish between residual/recurrent tumor and simple fibrotic tissue.
In addition,
in recent years chemotherapy has been modified: the ACCORD trial in 2011 demonstrated that the survival in PDAC with FOLFIRINOX (fluorouracil,
leucovorin,
oxaliplatin,
and irinotecan) is improved when compared with gemcitabine based regime [7].
Consequently,
commonly used response criteria (for example RECIST 1.1) may be no more adequate.
New imaging criteria have recently been suggested,
but their role is still unclear.
In the next section we will discuss the most useful imaging features to assess PDAC response to chemotherapy.