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The State of Maine Pancreatic Cancer Protocol: A Data Analysis of a Rural State's Neoadjuvant Treatment Collaborative
*Abby Crume, Lisa Rutstein, *David Lo, *Jennifer Lewis, *Douglas Howell
Maine Medical Center, Portland, ME

Objective
In December 2010 a Maine state protocol for pancreas cancer treatment was launched in an effort to improve access to care and patient outcomes. As part of this effort, a retrospective review of patients undergoing neoadjuvant chemoradiation therapy (CRT) with uncovered self-expanding metal stents (SEMS) was undertaken.
Design
Retrospective data analysis
Setting
A tertiary care center in conjunction with Maine hospitals participating in a collaborative neoadjuvant protocol
Patients
All patients with borderline resectable pancreas head adenocarcinoma (PA) who underwent SEMS placement and neoadjuvant chemoradiation between June 2008 and November 2010.
Interventions
Patients with biopsy proven PA had SEMS placed and underwent 8 weeks of combined Gemcitabine based chemotherapy and radiation with 4 weeks of recovery. Patients were restaged prior to resection.
Main Outcomes Measure
R0, R1 resection
Results
33 patients were identified. 4 patients were lost to follow up. The stage of the remaining 29 patients included IB (n=4), IIA (n=12) and IIB (n=13). 89.7% (n= 26) completed neoadjuvant therapy and underwent restaging. 31% (n=9) were deemed inoperable after restaging due to metastatic disease (n=4), local progression (n=1) or vascular involvement (n=4). 58.6% (n= 17) of the initial 29 were deemed surgical candidates. 44.8% (n=13) had R0 resection, 3.4% (n=1) had R1 resection and 10.3% (n=3) were unresectable due to metastatic disease (n=2) or vascular involvement (n=1).
Conclusions
Compared to published data, the use of neoadjuvant CRT with SEMs is a reasonable approach for borderline resectable PA as part of the Maine state protocol. More time and data are needed to determine the protocol’s impact on access to care, quality of life, and survival.


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May 5, 2014

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