Evaluation of pancreatic ductal carcinoma response after neoplastic adjuvant therapy

This is an automatically translated article.

Post by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital
Pancreatic carcinoma (PDAC) carries significant morbidity and mortality and remains one of the most difficult malignancies to treat. Individual patient and tumor factors need to be taken into account to provide an optimal, personalized approach. The following article evaluates the response of pancreatic ductal carcinoma after adjuvant neoplasia

1. Evaluation of pancreatic ductal carcinoma response after neoplastic adjuvant therapy

Conventional Ultrasound Abdominal (US) ultrasound is an economical and radiation-free investigation. It helps visualize diminishing pancreatic masses on unenhanced CT images. However, its role in the assessment of tumor response is very limited. However, US can be a useful tool to detect intra-abdominal complications and drug toxicity during the adjuvant treatment of neoplasia in metastatic pancreatic cancer. The most common adverse events of neoplastic adjuvant therapy for metastatic pancreatic cancer are neutropenic colitis and venous thrombosis, which are readily detectable by abdominal US .
Endoscopic ultrasound Endoscopic ultrasound (EUS) has evolved from a mere imaging modality to one that allows tissue diagnosis through fine-needle aspiration. It has been shown to be a valuable means of early detection and staging of pancreatic carcinoma, especially for lesions ≤3 cm, superior to multi-detector CT. Recently, the role of EUS in providing adjuvant treatment of neoplasia in pancreatic ductal carcinoma and its response assessment is rapidly emerging. Das et al conducted a large sample study to investigate the value of EUS in predicting preoperative tumor response of pancreatic ductal carcinoma following adjuvant neoadjuvant therapy. The results show that tumor size change after neoplastic adjuvant therapy on EUS is a sensitive marker to assess tumor response, and tumor size reduction 47% is a factor. independent prognosis for survival in these patients.
A systematic review from Barreto et al compared the accuracy of imaging modalities to predict resectability and R0 resection for peritumoural contour or advanced pancreatic ductal carcinoma in situ after neoplastic adjuvant therapy. They show that effective imaging evaluation allows predictability of tumor resection. Furthermore, the decrease in tumor stiffness of pancreatic ductal carcinoma on tissue elastomer EUS can be used as a potential marker for neoplastic adjuvant response and assessment of resection potential. u. In addition, Figueedlyo et al. reported the role of EUS-guided technology in performing neoplastic adjuvant therapy for pancreatic carcinoma. The authors point out that EUS-guided placement of fiducial markers for stereosystemic whole-body radiation therapy in pancreatic ductal adenocarcinoma helped ensure the feasibility and safety of adjuvant therapy. next new born. The above studies illustrate the importance of EUS during adjuvant neoplastic treatment for pancreatic carcinoma.

Multidetector CT (MDCT) is the most frequently used imaging modality to evaluate the response of pancreatic ductal carcinoma following adjuvant neoadjuvant therapy. Compared with other imaging techniques, its advantages include higher spatial resolution and multi-faceted reproducibility. However, recent studies have shown that the diagnostic efficacy of MDCT in evaluating tumor resection and redistribution of borderline tumors is not satisfactory. In a study of 129 patients with pancreatic adenocarcinoma at the margins of radical resection, the authors found that the response evaluation criteria commonly used in the solid tumor criteria (RECIST). ) is not suitable for assessing tumor response after neoplastic adjuvant therapy, as there is little morphological change on post-treatment imaging. A systematic review reported that only a small number of patients showed tumor recurrence after adjuvant neoplasia and that most patients (53%-80%) had stable disease. Similar results were also reported by a recent study showing that the assessment of resectability of MDCT after neoadjuvant neoadjuvant therapy was relatively insensitive and nonspecific for predicting R0 resection. , because MDCT cannot accurately distinguish between residual tumor and tissue scarring after tumor regress. Furthermore, localized acute pancreatitis was also indistinguishable from tumor infiltrates and the tumor infiltrate was replaced by fibrous tissue, which did not lead to obvious changes in size. tumor. All of these factors lead to an underestimation of the potential for tumor resection. Recently, several studies have begun to explore whether imaging features other than tumor size and enhancement on MDCT imaging can be used to assess tumor response in carcinoma. pancreatic ductal tissue or not. A study by Cassinotto et al showed that partial regression of tumor exposure to vasculature after neoplastic adjuvant therapy showed suitability for surgical exploration, regardless of the reduction in tumor size. tumor or residual vascular involvement. Another study by Amer et al suggested that changes in the pancreatic ductal/parenchymal carcinoma interface could be used as an early predictor of response to neoplastic adjuvant treatment. A recent study from Wei et al. showed that the largest tumor diameter and radiopaque tumor volume on post-treatment MDCT were related to pathological tumor stage and tumor response to adjuvant therapy. neonatal support. Although MDCT has high resolution in displaying morphological features of the tumor and surrounding vascular structures, it has low specificity due to the lack of obvious tumor reduction following neoadjuvant therapy. in pancreatic carcinoma, as well as the presence of fibrous tissue and localized pancreatitis. Therefore, MDCT has low specificity and sensitivity in the recovery of pancreatic ductal carcinoma following neoadjuvant therapy. However, further quantification and evaluation of imaging indicators on MDCT images can significantly improve the assessment of tumor response and prognostic value of patients with pancreatic ductal carcinoma after treatment. neonatal supplement.

Magnetic resonance imaging Magnetic resonance imaging (MRI) provides a better picture of the soft tissues and abnormalities of the pancreas and bile ducts. In pancreatic carcinoma, the high cellularity and fibrotic potential of the tumor impede the free movement of water molecules. This can be quantified by diffusion weighted imaging (DWI) on MRI, resulting in a low mean apparent diffusion coefficient (ADC) on the mean apparent diffusion coefficient map.
Positron emission tomography 18F-fluorodeoxyglucose positron emission tomography (18-F-FDG-PET) is a diagnostic test that reflects the genetic, molecular, metabolic, and functional status of a lesion. The maximum standardized uptake value (SUVmax) obtained by PET imaging reflects the glucose metabolism of the tumours. Choi et al explored the relationship between early treatment response after neoplastic adjuvant chemotherapy with FDG-PET and surgical outcome in advanced pancreatic ductal carcinoma in situ.
CT perfusion Pancreatic ductal carcinoma is a matrix-rich tumor characterized by activation of pancreatic astrocytes, which deposit large amounts of extracellular matrix. The accumulation of extracellular matrix, including collagen, fibronectin, proteoglycan, and hyaluronic acid, can cause the formation of a stiff extracellular matrix to compress blood vessels, leading to perfusion injury and ultimately impeding delivery of anticancer drugs to tumor cells.

2. Structural analysis and data modeling

In recent years, many studies have emphasized the role of data visualization techniques in various aspects of pancreatic tumours, such as tumor characterization, assessment of surgical viability, etc. , risk of recurrence and predictability of survival. A previous study by Chen et al showed changes in CT radiographic features, such as imaging changes during chemotherapy, in patients with pancreatic carcinoma. The authors suggest that these alterations can be used for early assessment of treatment response and patient stratification to achieve precise and intensive treatment. Chakraborty et al conducted a preliminary study to investigate the value of CT texture analysis in quantifying tumor heterogeneity and predicting 2-year survival in patients with carcinoma. pancreas. The results suggest that CT texture features can predict heterogeneity in pancreatic tumours. At the same time, the accuracy of CT texture analysis in predicting 2-year survival rate can reach 82.86%. Therefore, it can be used to develop optimal treatment plans for pancreatic carcinoma patients.
Recently, several studies have explored the utility of CT texture analysis in predicting operability and prognosis in patients with pancreatic ductal carcinoma and the relationship between texture features and the pathological response of the tumor. The results showed that CT texture characterization was more accurate in identifying tumors as resectable than unresectable. The authors conclude that pretreatment structural features of baseline CT images and longitudinal changes in tumor heterogeneity can be used as biomarkers to predict tissue response study with adjuvant chemotherapy and disease-free survival. In addition, Nasief et al. have reported the value of carbohydrate antigen 19-9 (CA19-9)-associated data visualization in the evaluation of neoplastic adjuvant therapy for adenocarcinoma. pancreas. The results showed that decreased CA19-9 levels and plain radiographic features were predictors of survival in these patients. The combination of delta-CA19-9 radioactivity features has the potential to increase adaptation to response-based treatment. It cannot be denied that data visualization or texture analysis has great promise in the management of pancreatic ductal carcinoma following adjuvant neoplasia. Current limitations of radiomics include time-consuming segmentation and uncertain conclusions. Further large-scale studies are needed to determine its true potential.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.