Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation respectability and staging in patients with pancreatic head cancer

Purpose: To evaluate the effectof neoaduunvat comhined chemothorayv and radiation therapy (CCRT) on preoperative accuracv of multidetector computed tomography (CT) for resectability and tumor staging in patients with pancreatic head rancor. Materials and 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 belween the patients with neoadjuvant CCRT and wiihoui it by using the X ² test or fisher evict test. A P of less than .05 was considered as significant. Results: The accuracy in determining resectability was 83% (10 of12) 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 staying was reported for T1 [n = 2), T2 (n = I), 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 = .0815). Conclusion: Neoadjuvant CCRT reduces the accuracy of tumor restaging after treatment, of pancreatic head cancer, but this effect is not so great as to affect die determination of resectability.