title: Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic head cancer.
abstract: OBJECTIVE
  To evaluate the effect of neoadjuvant combined chemotherapy and radiation therapy (CCRT) on preoperative accuracy of multidetector computed tomography (CT) for resectability and tumor staging in patients with pancreatic head cancer.
  
  
  METHODS
  This retrospective study received institutional review board approval and was exempted from informed consent requirements. From May 2002 to March 2007, 38 patients with pancreatic head adenocarcinoma underwent multidetector CT before surgery. Of these, 12 patients received neoadjuvant CCRT. Imaging findings were evaluated for tumor resectability and tumor staging. Surgical and pathologic results were used as the reference standard. The accuracy of resectability and individual components of each T category were compared between the patients with neoadjuvant CCRT and without it by using the chi(2) test or Fisher exact test. A P of less than .05 was considered as significant.
  
  
  RESULTS
  The accuracy in determining resectability was 83% (10 of 12) in patients who had received neoadjuvant CCRT and 81% (21 of 26) in patients who had not, without significant difference (P > .05). Of 32 patients who underwent pancreaticoduodenectomy, histopathologic tumor staging was reported for T1 (n = 2), T2 (n = 1), and T3 (n = 9) lesions in patents with neoadjuvant CCRT (n = 12), and for T3 in all patients without neoadjuvant CCRT (n = 20). T-staging accuracy was 67% (eight of 12) with neoadjuvant CCRT and 95% (19 of 20) without it, with a significant difference (P = .0185).
  
  
  CONCLUSIONS
  Neoadjuvant CCRT reduces the accuracy of tumor restaging after treatment of pancreatic head cancer, but this effect is not so great as to affect the determination of resectability.
authors.affiliation: Department of Radiology, Institute of Gastroenterology, Severance Hospital, Yonsei University Healthcare System, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Republic of Korea.
authors.forename: Yeo-Eun
authors.initials: YE
authors.lastname: Kim
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Park
authors.forename: Hye-Suk
authors.initials: HS
authors.lastname: Hong
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Joon Seok
authors.initials: JS
authors.lastname: Lim
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Ki Whang
authors.initials: KW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018579:Patient Selection; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome