Neoadjuvant Therapy, Changes in Body Composition, and Resectability in Pancreatic Cancer


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Carlos Fernández-del Castillo, MD

Carlos Fernández-del Castillo, MD

In a retrospective cohort study reported in JAMA Surgery, Carlos Fernández-del Castillo, MD, of the Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and colleagues found that neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma was associated with loss of adipose tissue but not muscle wasting. In addition, the study showed that an increase in skeletal muscle tissue was associated with resectability.

The study involved 193 patients with borderline resectable pancreatic cancer or locally advanced disease treated between January 2013 and December 2015 at 1 U.S. center and 3 Italian centers. The patients underwent surgical exploration after neoadjuvant therapy and had computed tomographic scans both at diagnosis and preoperatively.

The primary outcome measure was the achievement of pancreatic resection at surgical exploration. The most common neoadjuvant chemotherapy was combined therapy with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid (64%), and 45% of patients also received chemoradiotherapy. The median interval between pre-and postneoadjuvant therapy imaging was 6 months.

Changes in Body Composition and Resectability

Significant alterations were observed in all body compartments. Median total adipose tissue area decreased from 284.0 cm2 to 250.0 cm2 (P < .001), and median visceral adipose tissue area decreased from 115.2 cm2 to 97.7 cm2 (P < .001). Lean mass increased, with an increase in median skeletal muscle from 122.1 cm2 to 123 cm2 (P = .001).

Surgical resection was achieved in 136 patients (70.5%). Patients who underwent resection had a median increase in skeletal muscle area of 5.9% vs a 1.7% decrease among those who did not undergo resection (P < .001). No significant association between neoadjuvant treatment regimen and resectability was observed.

The investigators concluded, “Patients with [pancreatic cancer] experience a significant loss of adipose tissue during neoadjuvant chemotherapy, but no muscle wasting. An increase in muscle tissue during [neoadjuvant therapy] is associated with resectability.” ■

Sandini M, et al: JAMA Surg. May 9, 2018 (early release online).


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