January 24, 1997

New protocol offers hope to pancreatic cancer patients

New protocol offers hope to pancreatic cancer patients

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The team that developed VUMC's new pancreatic cancer protocol includes (from left) Drs. Hak Choyeven Leach and Daniel Beauchamp

A new protocol for treating pancreatic cancer developed at Vanderbilt University Medical Center is offering a ray of hope to patients stricken with the deadly disease.

The new treatment program ‹ the first of its kind in the Southeastern United States ‹ takes a multidisciplinary approach, combining the services of surgical, medical and radiation oncology with gastroenterology, pathology and diagnostic imaging in an attempt to prolong the lives of pancreatic cancer patients.

So far the new program is showing tangible results since it was implemented last July. Several patients have successfully completed the program and undergone apparently curative resection ‹ often when they had previously been told they had unresectable, incurable disease.

³We are in the early stages, but we are very excited,² said Dr. Steven D. Leach, Assistant Professor of Surgery. ³Our initial experience suggests this may indeed be a promising approach.²

Leach, Dr. Charles D. Blanke, assistant professor of Medicine, Dr. Hak Choy, associate professor of Radiology and Radiological Sciences, and Dr. R. Daniel Beauchamp, associate professor of Surgery, worked together to formulate the new treatment program under the auspices of the Vanderbilt Cancer Center.

Pancreatic cancer strikes 28,000 people each year in the United States, and 26,000 people die from the disease annually. These numbers make pancreatic cancer the ninth most commonly diagnosed cancer in the United States, but because of the disease¹s grim prognosis, it is the fifth leading cause of cancer death, Leach said.

³Traditionally, pancreatic cancer has been associated with very low rates of long-term survival. What we¹ve done in developing the Pancreatic Cancer Program is to build a team of specialists all dedicated to improving the outcome for patients with this disease,² he said.

Currently, surgery provides pancreatic cancer patients with the only chance for long-term cure, but this scenario is rare, Leach said.

³The reason is that most patients are surgically unresectable at the time of diagnosis. Only 10-20 percent of all patients have tumors that are resectable by surgery, and even when the tumor is resected, the five-year survival rate is still only 10-20 percent,² he said.

VUMC physicians involved in the new Pancreatic Cancer Program are trying to boost those odds by combining the newest techniques in preoperative chemoradiation with cutting edge surgical approaches.

³We¹ve built on previous programs and tried to take our treatment approach to the next level,² Leach said. ³We¹ve developed a program where a patient with potentially resectable pancreatic cancer is treated with chemotherapy and radiation therapy before surgery in hopes of downsizing the tumor and increasing the likelihood that the tumor can be resected in its entirety.

³Then we employ new surgical techniques, such as the ability to resect the portal vein and reconstruct it with vein grafts in a manner that allows us to extend the horizon in terms of who is resectable and who is not.

³Only those patients who have the opportunity to have their tumor completely resected have any hope of long-term cure.²

Leach said that the use of chemotherapy and radiation therapy before surgery increases the odds of performing a margin-negative resection, or the removal of the tumor in its entirety.

³Our prior experience with preoperative chemoradiation demonstrated an increase in the rate of margin-negative resection and a marked reduction in local tumor recurrence. Right now we are using taxol as a newer, and hopefully better, chemotherapeutic drug in order to take this to the next level, which is improving survival,² Leach said.

The key to improving the outlook for patients with pancreatic cancer is to get them into new treatment programs as early as possible, which is where VUMC¹s leading-edge diagnostic capabilities come into play, Leach said.

³Many health centers don¹t have the means to diagnose pancreatic cancer at its early stages except by doing surgery. Here, using CT-guided fine needle aspiration and endoscopic ultrasound-guided transduodenal biopsy, we have the unique ability to acquire tissue diagnoses at the earliest stages in a less invasive manner.

³This approach is much easier for the patient. It is also much easier for us to evaluate and treat the patient if they haven¹t already undergone attempts at surgical biopsy of their pancreatic tumor,² Leach said. ³By making a diagnosis before surgery, we¹re able to proceed directly with our chemoradiation program.²