The utility of Multi-Detector Computed Tomography criteria after neoadjuvant therapy in Borderline Resectable Pancreatic cancer: Prospective, bi-institutional study

Objectives: To evaluate the utility of MDCT criteria for the determination of resectability and tumor response in borderline resectable pancreatic cancer (BRPC) following neoadjuvant therapy (NAT).

Methods: This prospective study includes 90 consecutive BRPC patients who underwent surgery following NAT. Two radiologists assessed baseline and pre-surgical CTs for (largest tumor axis, size, attenuation, and vascular criteria). Logistic regression was used to determine which CT criteria independently associated with R0 resection and pathologic major response (pMR). Median survival and overall survival (OS) were calculated.

Results: Seventy-three/90 (81.1 %) patients had R0 resection, and 11/90 (12.2 %) had pMR. After NAT, there were significant interval changes in the largest tumor axis, size, attenuation, and venous burden index (VBI) (P < 0.02). On the multivariable analysis, regression of the VBI and low VBI at the pre-surgical CT were independently associated with an increased likelihood of R0 resection (OR 1.82; 95 % CI 1.44-5.33) (OR 1.91; 95 % CI 1.83-6.14). The assessment of VBI at the pre-surgical CT showed moderate reproducibility (k-value, 0.56 - 0.60). On the multivariable analysis, partial response (PR) was found to be independently associated with an increased likelihood of pMR (OR 1.71; 95 % CI 1.31-3.45). The median survival was longer in patients who had R0 (P = 0.01). The overall survival was longer in patients who had pMR compared to those who did not (P = 0.02).

Conclusion: Surgical exploration could be indicated in patients who had regression of the VBI and low VBI at the pre-surgical CT. PR response is associated with pMR.