Trends in the use of postoperative radiation therapy in patients with localized resectable pancreatic cancer

OBJECTIVES:: 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.