skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning

Abstract

Purpose: Pancreatic cancer primary tumor size measurements are often discordant between computed tomography (CT) and pathologic specimen after resection. Dimensions of the primary tumor are increasingly relevant in an era of highly conformal radiotherapy. Methods and Materials: We retrospectively evaluated 97 consecutive patients with resected pancreatic cancer at two Boston hospitals. All patients had CT scans before surgical resection. Primary endpoints were maximum dimension (in millimeters) of the primary tumor in any direction as reported by the radiologist on CT and by the pathologist for the resected gross fresh specimen. Endoscopic ultrasound (EUS) findings were analyzed if available. Results: Of the patients, 87 (90%) had preoperative CT scans available for review and 46 (47%) had EUS. Among proximal tumors (n = 69), 40 (58%) had pathologic duodenal invasion, which was seen on CT in only 3 cases. The pathologic tumor size was a median of 7 mm larger compared with CT size for the same patient (range, -15 to 43 mm; p < 0.0001), with 73 patients (84%) having a primary tumor larger on pathology than CT. Endoscopic ultrasound was somewhat more accurate, with pathologic tumor size being a median of only 5 mm larger compared with EUS size (range,more » -15 to 35 mm; p = 0.0003). Conclusions: Computed tomography scans significantly under-represent pancreatic cancer tumor size compared with pathologic specimens in resectable cases. We propose a clinical target volume expansion formula for the primary tumor based on our data. The high rate of pathologic duodenal invasion suggests a risk of duodenal undercoverage with highly conformal radiotherapy.« less

Authors:
 [1];  [2];  [3];  [4];  [2]
  1. Harvard Radiation Oncology Program, Boston, MA (United States)
  2. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
  3. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States)
  4. Department of Surgery, Massachusetts General Hospital, Boston, MA (United States)
Publication Date:
OSTI Identifier:
21587649
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 80; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2010.04.058; PII: S0360-3016(10)00672-3; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CAT SCANNING; HAZARDS; NEOPLASMS; PANCREAS; PATHOLOGY; RADIOTHERAPY; SURGERY; ULTRASONOGRAPHY; BODY; COMPUTERIZED TOMOGRAPHY; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; DISEASES; ENDOCRINE GLANDS; GLANDS; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY; TOMOGRAPHY

Citation Formats

Arvold, Nils D., Niemierko, Andrzej, Mamon, Harvey J., Fernandez-del Castillo, Carlos, and Hong, Theodore S., E-mail: Tshong1@partners.org. Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.04.058.
Arvold, Nils D., Niemierko, Andrzej, Mamon, Harvey J., Fernandez-del Castillo, Carlos, & Hong, Theodore S., E-mail: Tshong1@partners.org. Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning. United States. doi:10.1016/j.ijrobp.2010.04.058.
Arvold, Nils D., Niemierko, Andrzej, Mamon, Harvey J., Fernandez-del Castillo, Carlos, and Hong, Theodore S., E-mail: Tshong1@partners.org. Mon . "Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning". United States. doi:10.1016/j.ijrobp.2010.04.058.
@article{osti_21587649,
title = {Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning},
author = {Arvold, Nils D. and Niemierko, Andrzej and Mamon, Harvey J. and Fernandez-del Castillo, Carlos and Hong, Theodore S., E-mail: Tshong1@partners.org},
abstractNote = {Purpose: Pancreatic cancer primary tumor size measurements are often discordant between computed tomography (CT) and pathologic specimen after resection. Dimensions of the primary tumor are increasingly relevant in an era of highly conformal radiotherapy. Methods and Materials: We retrospectively evaluated 97 consecutive patients with resected pancreatic cancer at two Boston hospitals. All patients had CT scans before surgical resection. Primary endpoints were maximum dimension (in millimeters) of the primary tumor in any direction as reported by the radiologist on CT and by the pathologist for the resected gross fresh specimen. Endoscopic ultrasound (EUS) findings were analyzed if available. Results: Of the patients, 87 (90%) had preoperative CT scans available for review and 46 (47%) had EUS. Among proximal tumors (n = 69), 40 (58%) had pathologic duodenal invasion, which was seen on CT in only 3 cases. The pathologic tumor size was a median of 7 mm larger compared with CT size for the same patient (range, -15 to 43 mm; p < 0.0001), with 73 patients (84%) having a primary tumor larger on pathology than CT. Endoscopic ultrasound was somewhat more accurate, with pathologic tumor size being a median of only 5 mm larger compared with EUS size (range, -15 to 35 mm; p = 0.0003). Conclusions: Computed tomography scans significantly under-represent pancreatic cancer tumor size compared with pathologic specimens in resectable cases. We propose a clinical target volume expansion formula for the primary tumor based on our data. The high rate of pathologic duodenal invasion suggests a risk of duodenal undercoverage with highly conformal radiotherapy.},
doi = {10.1016/j.ijrobp.2010.04.058},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 80,
place = {United States},
year = {2011},
month = {8}
}