Sandini M, et al. - An evaluation was conducted to assess if neoadjuvant treatment (NT) affects muscle mass and adipose tissue in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced PC (LAPC). In addition, researchers assessed if there were potential differences between patients who ultimately underwent resection and those who did not. A significant loss of adipose tissue was observed in patients with PC during neoadjuvant chemotherapy, however, there appeared no muscle wasting. During NT, an increase in muscle tissue was noted to be correlated with resectability.

Methods

• From January 2013 to December 2015, this retrospective cohort study was conducted at 4 academic medical centers evaluating 193 patients with BRPC and LAPC undergoing surgical exploration after NT who had available computed tomographic scans (both at diagnosis and preoperatively) and confirmed pancreatic ductal adenocarcinoma.
• From September 2016 to May 2017, data analysis was performed.
• Using volume assessment software, measurement of body compartments was evaluated before and after NT.
• The areas of skeletal muscle, total adipose tissue, and visceral adipose tissue were assessed by a radiologist blinded to the patient outcome through a standardized protocol.
• NT was administered as intervention.
• Researchers assessed achievement of pancreatic resection at surgical exploration after the receipt of NT as the main outcome measure.

Results

• Complete radiologic imaging was available of 193 patients after NT; 96 (49.7%) were women; mean (SD) age at diagnosis was 64 (11) years.
• Combined therapy with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid was received by most of the patients (124 [64.2%]); 86 (44.6%) patients received chemoradiotherapy as well.
• The median interval of 6 months (interquartile range [IQR], 4-7 months) was noted between pre-NT and post-NT imaging.
• Significant change in all body compartments was noted.
• Researchers noted a decrease in the adipose compound (median total adipose tissue area from 284.0 cm²; IQR, 171.0-414.0 to 250.0 cm²; IQR, 139.0-363.0; P < .001; median visceral adipose tissue area from 115.2 cm²; IQR, 59.9-191.0 to 97.7 cm²; IQR, 48.0-149.0 cm2; P < .001), but a slight improvement in the lean mass (median skeletal muscle from 122.1 cm²; IQR, 99.3-142.0 to 123 cm² IQR 104.8-152.5 cm²; P=.001).
• In 136 (70.5%) patients, surgical resection was achievable.
• A 5.9% skeletal muscle area increase was observed among patients who underwent resection during NT treatment, however, those who did not undergo resection showed a 1.7% decrease (P < .001).