Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

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Abstract
The objective of this article is to define the main goals of initial pancreatic ductal adenocarcinoma (PDA) staging and to review the main results and limitations of the different imaging techniques at this time point. The scientific rationale for neoadjuvant therapy in patients with nonmetastatic PDA is detailed. The challenges raised by assessing the imaging-study response to neoadjuvant therapy are discussed. Pancreatic ductal adenocarcinoma (PDA) remains among the most challenging malignancies to treat. At diagnosis, the tumor often already extends beyond the confines of the pancreas, spreading to an extent such that primary surgery with curative intent is very rarely feasible. Considerable momentum is now being given to a treatment strategy involving neoadjuvant chemotherapy or chemotherapy and radiation therapy in patients with nonmetastatic PDA. The main advantage of this strategy is better selection of patients likely to benefit from curative-intent surgery through the achievement of negative resection margins. Patients with rapidly progressive disease are identified and are spared ineffective surgery with its attendant morbidity. Neoadjuvant therapy can downstage tumors classified as locally advanced at initial imaging studies to resectable tumors. However, the imaging study evaluation of the response to neoadjuvant therapy is extremely complex. Thus, the diagnostic performance of imaging studies is not ...

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