title: Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy?
abstract: OBJECTIVE
  In patients with borderline resectable pancreas cancers, clinicians frequently consider radiographic response as the primary driver of whether patients should be offered surgical intervention following neoadjuvant therapy (NT). We sought to determine any correlation between radiographic and pathologic response rates following NT.
  
  
  METHODS
  Between 2005 and 2015, 38 patients at a tertiary care referral center underwent NT followed by pancreaticoduodenectomy for borderline resectable pancreas cancer. Radiographic response after the completion of NT and pathologic response after surgery were graded according to RECIST and Evans' criteria, respectively.
  
  
  RESULTS
  Preoperatively, 50% of patients underwent chemotherapy alone and 50% underwent chemotherapy and chemoradiation. Radiographically, one patient demonstrated a complete radiologic response, 68.4% (n = 26) of patients had stable disease (SD), 26.3% (n = 10) demonstrated a partial response, and one patient had progressive. Among patients without radiographic response, 77.7% (n = 21) achieved a R0 resection. Of patients with SD on imaging, 26.9% (n = 7) had Evans grade IIB or greater pathologic response.
  
  
  CONCLUSIONS
  Our data indicate that approximately one-fourth of patients who did not have a radiologic response had a grade IIB or greater pathologic response. In the absence of metastatic progression, lack of radiographic down-staging following NT should not preclude surgery.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Brent T
authors.initials: BT
authors.lastname: Xia
authors.affiliation: Department of Pathology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Baojin
authors.initials: B
authors.lastname: Fu
authors.affiliation: Department of Pathology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Young
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: S Ameen
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Vikrom K
authors.initials: VK
authors.lastname: Dhar
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Nick C
authors.initials: NC
authors.lastname: Levinsky
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: David A
authors.initials: DA
authors.lastname: Habib
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Milton
authors.initials: M
authors.lastname: Smith
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Olugbenga O
authors.initials: OO
authors.lastname: Olowokure
authors.affiliation: Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jordan
authors.initials: J
authors.lastname: Kharofa
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Al Humaidi
authors.affiliation: Department of Radiology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Kyuran A
authors.initials: KA
authors.lastname: Choe
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Univesity of Wisconsin, Madison, Wisconsin.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018395:CA-19-9 Antigen / Q000097:blood; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D017239:Paclitaxel / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D018395:CA-19-9 Antigen; D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D000069347:Erlotinib Hydrochloride; D017239:Paclitaxel; D002955:Leucovorin; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: borderline resectable pancreatic cancer; neoadjuvant therapy; pathologic response; radiologic response