title: CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma.
abstract: OBJECTIVE
  To assess anatomic changes on computed tomography (CT) after neoadjuvant FOLFIRINOX (5-fluorouracil/leucovorin/irinotecan/oxaliplatin) chemotherapy for secondary resected borderline resectable (BR) and locally advanced (LA) pancreatic adenocarcinoma and their accuracy to predict resectability and pathological response.
  
  
  METHODS
  Thirty-six patients with secondary resected BR/LA pancreatic adenocarcinoma after neoadjuvant FOLFIRINOX chemotherapy (± chemoradiotherapy) were retrospectively included. Two radiologists reviewed baseline and pre-surgical CTs in consensus. NCCN (National Comprehensive Cancer Network) classification, largest axis, product of the three axes (P3A), and arterial/venous involvement were studied and compared to pathological response and resection status and to disease-free survival (DFS).
  
  
  RESULTS
  Thirty-one patients had R0 resection, including only six exhibiting a downstaging according to the NCCN classification. After treatment, the largest axis and P3A decreased (P < 0.0001). The pre-surgical largest axis and P3A were smaller in case of R0 resection (P = 0.019/P = 0.021). The largest axis/P3A variations were higher in case of complete pathological response (P = 0.011/P = 0.016). A decrease of the arterial/venous involvement was not able to predict R0 or ypT0N0 (P > 0.05). Progression of the vascular involvement was seen in two (5 %) patients and led to a shorter DFS.
  
  
  CONCLUSIONS
  In BR/LA pancreatic adenocarcinoma after the neoadjuvant FOLFIRINOX regimen (± chemoradiotherapy), significant tumour size decreases were observed on CT. However, CT staging was not predictive of resectability and pathological response.
  
  
  CONCLUSIONS
  • Significant tumour size decreases were observed on CT after FOLFIRINOX (± chemoradiotherapy). • CT is not able to predict R0 resection accurately after FOLFIRINOX (± chemoradiotherapy). • CT is not able to predict complete response accurately after FOLFIRINOX (± chemoradiotherapy). • Even with a stable NCCN classification, BR/LA pancreatic adenocarcinoma could have R0 resection.
authors.affiliation: UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France. mathilde.wagner@aphp.fr.
authors.forename: Mathilde
authors.identifier: http://orcid.org/0000-0003-1172-4592
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Department of Radiology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Celia
authors.initials: C
authors.lastname: Antunes
authors.affiliation: UPMC, Department of Digestive and Hepatobiliary Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pietrasz
authors.affiliation: Department of Diagnostic and Interventional Imaging, Hôpital Haut Levêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cassinotto
authors.affiliation: Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Paris Nord Val de Seine, Clichy, France.
authors.forename: Magaly
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Department of Hepatobiliary Surgery, Liver Transplant Center, Hôpital Paul Brousse, Hôpitaux Universitaires Paris Sud, Villejuif, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.affiliation: UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France.
authors.forename: Oliver
authors.initials: O
authors.lastname: Lucidarme
authors.affiliation: UPMC, Department of Gastroenterology and Digestive Oncology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonnes Universités, Paris, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Bachet
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage*; D000077150:Oxaliplatin; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D011838:Radiation-Sensitizing Agents / Q000494:pharmacology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D009944:Organoplatinum Compounds; D011838:Radiation-Sensitizing Agents; D000077150:Oxaliplatin; D014803:Vitamin B Complex; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Computed tomography; FOLFIRINOX; Neoadjuvant treatment; Pancreatic adenocarcinoma; Staging