Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic head cancer.
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.
Kim
Yeo-Eun
YE
Department of Radiology, Institute of Gastroenterology, Severance Hospital, Yonsei University Healthcare System, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Republic of Korea.
Park
Mi-Suk
MS
Hong
Hye-Suk
HS
Kang
Chang Moo
CM
Choi
Jin-Young
JY
Lim
Joon Seok
JS
Lee
Woo Jung
WJ
Kim
Myeong-Jin
MJ
Kim
Ki Whang
KW
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