- Design
- Scoping review of CT and PET/CT restaging studies
- Population
- 20 studies of localized pancreatic ductal adenocarcinoma after systemic therapy (15 CT, 5 PET/CT)
- Primary outcome
- Association of restaging methods with resectability, overall survival and R0 resection
- Effect
- Inconsistent associations; no method consistently linked to both R0 resection and survival
Modern multi-agent chemotherapy has made restaging of localized pancreatic ductal adenocarcinoma harder: a tumour can respond biologically with little change in size. This scoping review searched MEDLINE, Embase and CENTRAL, screened 4,680 records and included 20 studies, 15 of CT and 5 of PET/CT. It looked at how restaging methods relate to resectability, overall survival and R0 resection.
Methods ranged from new response categories and size metrics to tumour volume, vascular contact, attenuation, PET metabolic parameters and resectability criteria. Dual-energy CT extracellular volume was assessed as a baseline predictor. Associations were reported inconsistently, with some methods significant in some studies and not in others, and no method was consistently associated with both R0 resection and survival.
The authors conclude that RECIST 1.1 has limited accuracy here, particularly for partial response and stable disease, and that adding imaging features, other modalities and CA19-9 may help. For the reporting radiologist, the practical message is to describe vascular contact and tumour changes explicitly and avoid letting a RECIST category alone drive the resectability discussion.
- RECIST 1.1 is least reliable for partial response and stable disease after systemic therapy.
- No restaging method was consistently linked to both R0 resection and survival.
- Describe vascular contact and tumour attenuation changes in the report, not only size.
- Interpret imaging with CA19-9 and in a multidisciplinary meeting.
- A stable-disease label should not by itself exclude surgical review.
Why it matters
A RECIST category after chemotherapy can mislead the decision on whether to operate.
Don't overread it
A scoping review with inconsistent, mostly retrospective studies does not provide a validated alternative to RECIST.
The statistics, in plain English
A scoping review maps what exists and does not pool results, so it cannot give a single accuracy figure. Inconsistent findings across 20 studies mean current evidence cannot yet name a best method, not that all methods are equally poor.
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