Trends in the use of pre-operative radiation for adenocarcinoma of the pancreas in the United States.
BACKGROUND
The benefit and timing of radiation therapy (RT) for patients undergoing a resection for pancreatic adenocarcinoma remains unclear. This study identifies trends in the use of radiation over a 10-year period and factors associated with the use of pre-operative radiation, in particular.


METHODS
The Surveillance, Epidemiology and End Results registry was used to identify patients aged ≥18 years with pancreatic adenocarcinoma who underwent a surgical resection between 2000 and 2010. Logistic regression was used to identify time trends and factors associated with the use of pre-operative radiation.


RESULTS
The overall use of radiation decreased with time among the 8474 patients who met the inclusion criteria. However, the use of pre-operative radiation increased from 1.8% to 3.9% (P ≤ 0.05). Factors significantly associated with receipt of pre-operative radiation were younger age, treatment in more recent years and having an advanced T-stage tumour. The 5-year hazard of death was significantly less for those who received pre-operative radiation versus surgery alone [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.55-0.74] and for those who received post-operative radiation versus surgery alone (HR 0.69, 95% CI 0.65-0.73).


CONCLUSIONS
The use of pre-operative radiation significantly increased during the study period. However, the overall use of pre-operative radiation therapy remains low in spite of the potential benefits.
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Erin E
EE
Burke
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.|School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Schelomo
S
Marmor
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Pamela R
PR
Portschy
School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Beth A
BA
Virnig
Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA.
Lawrence C
LC
Cho
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Todd M
TM
Tuttle
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Eric H
EH
Jensen
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000639:trends; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult