Contrast agent dispersion visualized by CE-EUS may be a prediction tool for FOLFIRINOX chemotherapy effectiveness in patients with pancreatic adenocarcinoma.
Mike J P de Jong, Foke van Delft, Fer D W Radstake, Tom H Perik, Geke Litjens, Tanya M Bisseling, Fons van der Sommen, Erwin-Jan M van Geenen, John J Hermans, Peter D Siersema
Author Information
Mike J P de Jong: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: mike.dejong@radboudumc.nl.
Foke van Delft: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Fer D W Radstake: Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
Tom H Perik: Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
Geke Litjens: Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands.
Tanya M Bisseling: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Fons van der Sommen: Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
Erwin-Jan M van Geenen: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
John J Hermans: Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
Peter D Siersema: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) still has a dismal 5-year overall survival of 13 %. Chemotherapy is increasingly used as treatment in both (neo-) adjuvant and palliative conditions. However, the overall survival benefits of chemotherapy must be weighed against significant side effects leading to a reduction in quality of life. CE-EUS and elastography could provide additional information about the vascularization and elasticity of the pancreatic tumor. The aim of this study was to investigate if contrast-enhanced endoscopic ultrasound and/or elastography could be suitable to predict the effectiveness of FOLFIRINOX. METHODS: Single center, prospective proof-of-concept study in which intravenous contrast agent was administered and strain ratio was calculated in patients undergoing EUS in their regular diagnostic work-up. Directly after contrast administration, a video of 120 s was recorded and afterwards tracked and fitted by a Modified Local Density Random Walk (mLDRW) model. RESULTS: We included 17 patients. Based on cross-sectional imaging based RECIST criteria, chemotherapy treatment was effective in 11 patients and not effective in 6 patients. The contrast dispersion parameter (��1) differed significantly between both groups in favor of the responders: 2.994 (IQR 1.670-5.170) vs 1.203 (IQR 0.953-1.756), p = 0.005. The elastography strain ratio was higher in the effectively treated group (20.9 vs 13.6, p = 0.138). CONCLUSION: This proof-of-concept study showed that the dispersion parameter of the first wave of contrast was 2.5 times higher in patients in whom FOLFIRINOX was effective, suggesting that this parameter could possibly be a reliable prediction tool.
