Necrosis volume and Choi criteria predict the response to endoscopic ultrasonography-guided HybridTherm ablation of locally advanced pancreatic cancer

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided ablation of pancreatic ductal adenocarcinoma (PDAC) with HybridTherm-Probe (EUS-HTP) is feasible and safe, but the radiological response and ideal tool to measure it have not been investigated yet. The aims of this study were to: 1) assess the radiological response to EUS-HTP evaluating the vital tumor volume reduction rate, Response Evaluation Criteria in Solid Tumors (RECIST1.1) and Choi criteria; 2) determine the prognostic predictive yield of these criteria. Patients and methods A retrospective analysis was performed of patients with locally advanced PDAC after primary treatment or unfit for chemotherapy prospectively treated by EUS-HTP. Computed tomography scan was performed 1 month after EUS-HTP to evaluate: 1) vital tumor volume reduction rate (VTVRR) by measuring necrosis and tumor volumes through a computer-aided detection system; and 2) RECIST1.1 and Choi criteria. Results EUS-HTP was feasible in 22 of 31 patients (71 %), with no severe adverse events. Median post-HTP survival was 7 months (1 – 35). Compared to pre-HTP tumor volume, a significant 1-month VTVRR (mean 21.4 %) was observed after EUS-HTP (P = 0.005). We identified through ROC analysis a VTVRR > 11.46 % as the best cut-off to determine post-HTP 6-month survival outcome (AUC = 0.733; sensitivity = 70.0 %, specificity = 83.3 %). This cut-off was significantly associated with longer overall survival (HR = 0.372; P = 0.039). According to RECIST1.1 and Choi criteria, good responders to EUS-HTP were 60 % and 46.7 %, respectively. Good responders according to Choi, but not to RECIST1.1, had longer survival (HR = 0.407; P = 0.04). Conclusions EUS-HTP induces a significant 1-month VTVRR. This effect is assessed accurately by evaluation of necrosis and tumor volumes. Use of VTVRR and Choi criteria, but not RECIST 1.1 criteria, might identify patients who could benefit clinically from EUS-HTP.

[1]  C. Bassi,et al.  Ablation treatments in unresectable pancreatic cancer. , 2019, Minerva chirurgica.

[2]  Emiliano Schena,et al.  Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies , 2018, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[3]  M. Cham,et al.  The Added Value of Computer-aided Detection of Small Pulmonary Nodules and Missed Lung Cancers , 2018, Journal of thoracic imaging.

[4]  C. Bassi,et al.  Palliative therapy in pancreatic cancer-interventional treatment with radiofrequency ablation/irreversible electroporation. , 2018, Translational gastroenterology and hepatology.

[5]  S. Curley,et al.  Pancreatic adenocarcinoma response to chemotherapy enhanced with non-invasive radio frequency evaluated via an integrated experimental/computational approach , 2017, Scientific Reports.

[6]  Kenneth J. Chang,et al.  Endoscopic Ultrasound-Guided Direct Intervention for Solid Pancreatic Tumors , 2017, Clinical endoscopy.

[7]  Minhu Chen,et al.  Early evaluation of sunitinib for the treatment of advanced gastroenteropancreatic neuroendocrine neoplasms via CT imaging: RECIST 1.1 or Choi Criteria? , 2017, BMC Cancer.

[8]  G. Capurso,et al.  Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook , 2017, World journal of gastrointestinal endoscopy.

[9]  Lukas Ebner,et al.  Maximum-Intensity-Projection and Computer-Aided-Detection Algorithms as Stand-Alone Reader Devices in Lung Cancer Screening Using Different Dose Levels and Reconstruction Kernels. , 2016, AJR. American journal of roentgenology.

[10]  T. Pfammatter,et al.  Ablation Strategies for Locally Advanced Pancreatic Cancer , 2016, Digestive Surgery.

[11]  P. Pickhardt,et al.  The Liver Segmental Volume Ratio for Noninvasive Detection of Cirrhosis: Comparison With Established Linear and Volumetric Measures , 2016, Journal of computer assisted tomography.

[12]  A. Padhani,et al.  Therapy Monitoring with Functional and Molecular MR Imaging. , 2016, Magnetic resonance imaging clinics of North America.

[13]  F. Izzo,et al.  Early Assessment of Colorectal Cancer Patients with Liver Metastases Treated with Antiangiogenic Drugs: The Role of Intravoxel Incoherent Motion in Diffusion-Weighted Imaging , 2015, PloS one.

[14]  A. Jacobs,et al.  Radiofrequency Ablation for Liver Cancer. , 2015, Radiologic technology.

[15]  Y. Huang,et al.  Tumor volume reduction rate is superior to RECIST for predicting the pathological response of rectal cancer treated with neoadjuvant chemoradiation: Results from a prospective study. , 2015, Oncology letters.

[16]  T. Chua,et al.  Heat Sink Phenomenon of Bipolar and Monopolar Radiofrequency Ablation Observed Using Polypropylene Tubes for Vessel Simulation , 2014, Surgical innovation.

[17]  Mohamed Bouattour,et al.  Alternative Response Criteria (Choi, European association for the study of the liver, and modified Response Evaluation Criteria in Solid Tumors [RECIST]) Versus RECIST 1.1 in patients with advanced hepatocellular carcinoma treated with sorafenib. , 2014, The oncologist.

[18]  D. Dupuy,et al.  Thermal ablation of tumours: biological mechanisms and advances in therapy , 2014, Nature Reviews Cancer.

[19]  Lihua He,et al.  Combination Treatment With Comprehensive Cryoablation and Immunotherapy in Metastatic Pancreatic Cancer , 2013, Pancreas.

[20]  C. Bassi,et al.  Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center , 2013, Journal of hepato-biliary-pancreatic sciences.

[21]  M. Reni,et al.  Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. , 2012, Gastrointestinal endoscopy.

[22]  M. Ychou,et al.  MR volumetric measurement of low rectal cancer helps predict tumor response and outcome after combined chemotherapy and radiation therapy. , 2012, Radiology.

[23]  Richard S. Kwon,et al.  A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. , 2012, The New England journal of medicine.

[24]  C. Doglioni,et al.  US-guided application of a new hybrid probe in human pancreatic adenocarcinoma: an ex vivo study. , 2010, Gastrointestinal endoscopy.

[25]  B. Petersen,et al.  A lexicon for endoscopic adverse events: report of an ASGE workshop. , 2010, Gastrointestinal endoscopy.

[26]  M F Reiser,et al.  [Volumetry of metastases from renal cell carcinoma: comparison with the RECIST criteria]. , 2008, Der Radiologe.

[27]  M. Reiser,et al.  Volumetrie von Metastasen beim Nierenzellkarzinom , 2008, Der Radiologe.

[28]  C. Doglioni,et al.  Endoscopic ultrasound-guided application of a new internally gas-cooled radiofrequency ablation probe in the liver and spleen of an animal model: a preliminary study , 2008, Endoscopy.

[29]  C. Doglioni,et al.  Endoscopic ultrasound-guided application of a new hybrid cryotherm probe in porcine pancreas: a preliminary study , 2008, Endoscopy.

[30]  Haesun Choi,et al.  Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  Junfeng Xiong,et al.  Improved False Positive Reduction by Novel Morphological Features for Computer-Aided Polyp Detection in CT Colonography , 2019, IEEE Journal of Biomedical and Health Informatics.

[32]  C. Bassi,et al.  Results of 100 pancreatic radiofrequency ablations in the context of a multimodal strategy for stage III ductal adenocarcinoma , 2012, Langenbeck's Archives of Surgery.

[33]  E. Nakakura,et al.  Pancreatic Adenocarcinoma , 2019 .

[34]  L. Schwartz,et al.  New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). , 2009, European journal of cancer.