Back to 2011 Program
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.
Back to 2011 Program
|
|