Changes in Tumor Vascularity Depicted by Contrast-Enhanced Ultrasonography as a Predictor of Chemotherapeutic Effect in Patients With Unresectable Pancreatic Cancer

Objectives: This study was conducted to assess changes in tumor vascularity using contrast-enhanced ultrasonography in patients with pancreatic carcinoma under systemic chemotherapy and to examine the correlation among vascular change, clinicopathologic factors, and outcome. Methods: Forty-one consecutive patients with histopathologically confirmed pancreatic carcinoma who had distant metastases and were under systemic chemotherapy were recruited. Contrast-enhanced ultrasonography was performed before and after 1 and 2 cycles of treatment. The vascular signals from the tumor were continuously recorded, and the highest signal intensity was selected and classified into 5 categories by their intensity. Results: As for the tumor response determined by dynamic computed tomography after 2 cycles, 6 patients showed a partial response, 25 remained stable, and in 10 patients, the disease progressed. A significant relationship was observed between vascular change after 1 cycle and tumor response (P < 0.001). Progression-free survival and overall survival were significantly short in the case of patients showing increased vascularity after 1 and 2 cycles of chemotherapy, compared with those who did not (P < 0.001). Conclusions: Contrast-enhanced ultrasonography was useful to evaluate tumor vascular changes and thereby the effect of systemic chemotherapy, as well as the prognosis of patients with advanced pancreatic carcinoma.