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Intranetwork variation in neoadjuvant therapy delivery for borderline resectable and locally advanced pancreatic
P L Labib1, M Alarabiyat1, S Powell-Brett1,2
1Queen Elizabeth Hospital Birmingham, UK.
Introduction:
Pancreatic cancer (PC) treatment in the UK is coordinated via regional referral networks, but formal neoadjuvant chemotherapy (NAC) pathways for borderline resectable and locally advanced PC (BR/LAPC) are rare. This cohort study assessed intranetwork variation in access to diagnostics, time to treatment and patient outcomes following NAC for BR/LAPC in our network.
Methods:
All patients with BR/LAPC referred from regional network hospitals between 2017 and 2021 were reviewed. Data were collected on time from first diagnostic computed tomography scan to endoscopy, commencement of NAC, NAC regimens administered and patient outcomes.
Results:
In the 155 patients who commenced NAC, there were significant differences in median time to biliary drainage and endoscopic ultrasound between referral hospitals. Time from decision to treat to first administration of NAC was long (median 64 days). There were significant differences in the proportion of patients commenced on mFOLFIRINOX (0-100%, p<0.001) and the proportion completing NAC (0-100%, p=0.012). The likelihood of proceeding to surgical resection was similar between centres.
Conclusions:
There is significant intranetwork variation in access to interventional endoscopy and choice of NAC regimen. Centralised tracking of patients receiving NAC, development of locally agreed treatment protocols and an update to national guidelines are needed to standardise NAC pathways for BR/LAPC.
