title: Trends in the use of postoperative radiation therapy in patients with localized resectable pancreatic cancer.
abstract: OBJECTIVE
  : Results from European Study Group for Pancreatic Cancer (ESPAC)-1, first published in 2001, suggested that postoperative radiation therapy (PORT) was detrimental in pancreatic patients. The potential association between the publication of ESPAC-1 and the use of PORT in the United States is examined in this study.
  
  
  METHODS
  : Data from the Surveillance, Epidemiology, and End Results program were used to identify pancreatic patients treated with surgical resection followed by PORT. The use of PORT was examined in the 5-year time period preceding and after the publication of ESPAC-1.
  
  
  RESULTS
  : Univariable analysis of the use of PORT found significantly less use of PORT in the postpublication period [odds ratio (OR) for the use of PORT in prepublication period=1.19, 95% confidence interval (CI), 1.04-1.35]. A multivariable analysis, performed to account for imbalances in clinical and demographic variables between the 2 time periods, found similar results (OR=1.18, 95% CI, 1.03-1.35). When other types of radiation, such as preoperative radiation were included, no significant difference between time periods was found (OR=0.99, 95% CI, 0.76-1.30).
  
  
  CONCLUSIONS
  : Although there continues to be frequent use of PORT in the United States, the publication of ESPAC-1 seems to be associated with a small but significant change in its use. However, it is important to note that further analyses suggest that a small shift toward more preoperative radiation may also account for the decrease in PORT.
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA. eric.t.shinohara@vanderbilt.edu
authors.forename: Eric T
authors.initials: ET
authors.lastname: Shinohara
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Wan
authors.initials: W
authors.lastname: Fei
authors.forename: Austin N
authors.initials: AN
authors.lastname: Kirschner
authors.forename: James M
authors.initials: JM
authors.lastname: Metz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011182:Postoperative Care / Q000706:statistics & numerical data / Q000639:trends*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends*; D016032:Randomized Controlled Trials as Topic; D018426:SEER Program; D012693:Serial Publications; D014481:United States