Identifying prognostic intratumor heterogeneity using pre- and post-radiotherapy 18F-FDG PET images for pancreatic cancer patients

Unresectable pancreatic adenocarcinoma (PA) is associated with high mortality (1,2). Surgical resection is the only potentially curative treatment for PA (3,4). The use of chemoradiotherapy (CRT) in the management of borderline resectable (BR) and locally advanced (LA) PA has been historically used as a means to improve local control and down-staging to resectability (5-8). However, accurate evaluation of post-CRT response with standard body CT imaging and RECIST criteria is challenging and often fails to accurately characterize response (9,10). Indeed, identifying those patients at high likelihood for margin negative resection or escalation of radiation dose is essential to maximize the surgical benefit, reduce mortality of surgery and financial burden for those patients who potentially have no benefit from resection