Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2017; 23(26): 4767-4778
Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4767
Early radiological assessment of locally advanced pancreatic cancer treated with electrochemotherapy
Vincenza Granata, Roberta Fusco, Sergio Venanzio Setola, Mauro Piccirillo, Maddalena Leongito, Raffaele Palaia, Francesco Granata, Secondo Lastoria, Francesco Izzo, Antonella Petrillo
Vincenza Granata, Roberta Fusco, Sergio Venanzio Setola, Secondo Lastoria, Antonella Petrillo, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, “Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli”, 80131 Naples, Italy
Mauro Piccirillo, Maddalena Leongito, Raffaele Palaia, Francesco Izzo, Department of Surgical Oncology, Hepatobiliary Unit, “Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli”, 80131 Naples, Italy
Francesco Granata, Departement of Civil and Mechanical Engineering, “University of Cassino and Southern Lazio”, Viale dell'Università, 03043 Cassino, Italy
Author contributions: Granata V, Izzo F and Petrillo A designed research and supervised the research; Granata V, Fusco R, Setola SV, Piccirillo M, Leongito M, Lastoria S, Izzo F and Petrillo A performed research; Fusco R analyzed data; Granata V and Fusco R wrote the paper; all authors read and approved the final manuscript.
Institutional review board statement: The patients were enrolled in a clinical phase I/II study approved by the Ethical Committee of the National Cancer Institute “G. Pascale Foundation - IRCCS” of Naples (deliberation n. 482 of 02/07/2014).
Informed consent statement: All patients enrolled have signed the informed consensus.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberta Fusco, PhD, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, “Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli”, via Mariano Semmola, 80131 Naples, Italy. r.fusco@istitutotumori.na.it
Telephone: +39-08-1590714 Fax: +39-08-15903825
Received: February 3, 2017
Peer-review started: February 9, 2017
First decision: February 23, 2017
Revised: March 1, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: July 14, 2017
Processing time: 159 Days and 4.1 Hours
Abstract
AIM

To report early imaging assessment of ablated area post electrochemotherapy (ECT) in patients with locally advanced pancreatic cancer (LAPC).

METHODS

ECT was performed in 19 LAPC patients enrolled in an approved ongoing clinical phase I/II study. Before and after ECT, 18 patients underwent computed tomography (CT) scan, 11 patients underwent morphological and functional magnetic resonance (MR) scan (dynamic contrast enhanced-MRI) calculating wash-in slope (WIS) and wash-out slope (WOS); diffusion weighted imaging calculating pseudo-diffusivity (Dp), perfusion fraction (fp) and tissue diffusivity (Dt); 10 patients underwent positron emission tomography (PET). Response evaluation criteria in solid tumour (RECIST) on MR and CT were used to assess tumour therapy response. Choi on CT, PET response criteria in solid tumors (PERCIST) on PET and functional parameters on MR were used to evaluate treatment response.

RESULTS

For each patient no significant reduction was measurable by CT and MR using RECIST. According Choi criteria a partial response was obtained in 18/18 (100.0%) patients. According PERCIST criteria 6/10 (60.0%) patients showed a partial response, 3/10 (30.0%) stable disease and 1/10 (10.0%) progression disease. Moreover, using functional MR parameters, a significant reduction of viable tumour after ECT can be observed. According ΔWIS and ΔWOS 9/11 (81.8%) patients exhibited a partial response and 2/11 (18.2%) stable disease; 8/11 (72.7%) patients were considered in partial response by ΔDp evaluation and 3/11 (27.3%) in stable disease; according ΔDt 7/11 (63.6%) patients showed a partial response, 1/11 (9.1%) showed progression of disease and 3/11 (27.3%) were stable. Perfusion fraction fp showed a significant reduction after ECT only in four patients. No significant difference was observed after ECT in signal intensity of T1-weighted images and T2-weighted images, and in equilibrium-phase of contrast study, according to χ2 test was observed. A good correlation was reported between ΔHounsfield unit and Δmaximum standardized uptake value and between Δfp and ΔWOS, with a significant statistically difference (P < 0.05) using Spearman correlation coefficient.

CONCLUSION

Perfusion and diffusion MR derived parameters, Choi, PERCIST criteria are more performant than morphological MR and CT criteria to assess ECT treatment response.

Keywords: Reversible electroporation; Response assessment; Positron emission tomography/computed tomography; Pancreatic cancer; Magnetic resonance imaging

Core tip: Aim of this study was to assess and to report early imaging assessment of ablated area post electrochemotherapy in patients with locally advanced pancreatic cancer emphasizing the role of new functional imaging tools in magnetic resonance imaging compared to standard morphological response evaluation criteria in solid tumour, Choi criteria and positron emission tomography response evaluation criteria in solid tumour.