Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer
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Pancreatic cancer is considered a systemic disease at presentation. Therefore, multimodality therapy with surgical resection and chemotherapy is the standard of care for locoregional disease. We described treatment patterns and time trends with regard to age and treatment center in the receipt of multimodality therapy.
We used the National Cancer Data Base to identify patients ≥18 years old with stage I and II pancreatic adenocarcinoma. Treatment was defined as no treatment, resection only, chemotherapy only, or multimodality therapy, which consisted of both chemotherapy (neoadjuvant or adjuvant) and resection. Trends in the receipt and type of treatment were compared.
Of 39,441 patients, 22.8 % of patients received no treatment, 18.5 % received chemotherapy only, 23.0 % underwent surgical resection alone, and 35.8 % of patients received multimodality therapy. Receipt of multimodality therapy increased from 31.3 % in 2004 to 37.9 % in 2011 (p < 0.0001). Patients >55 years were less likely to receive multimodality therapy (56–64 years: OR 0.83, 95 % CI 0.78–0.89; 65–75: OR 0.60, 95 % CI 0.55–0.65; ≥76: OR 0.17, 95 % CI 0.16–0.19 compared to patients 18–55). Compared to community hospitals, patients treated at an NCI-designated center were more likely to receive multimodality therapy (OR 1.62, 95 % CI 1.46–1.81) and, if they received multimodality therapy, delivery of chemotherapy in the neoadjuvant compared to adjuvant setting (OR 2.82, 95 % CI 2.00–3.98).
Despite increased use of multimodality therapy, it remains underutilized in all patients and especially in older patients. Receipt of multimodality therapy and neoadjuvant therapy is highly dependent on treatment at NCI-designated cancer centers.
KeywordsPancreatic cancer Multimodality therapy Pancreatic adenocarcinoma Pancreas Therapy Treatment
Supported by grants from the Cancer Prevention Research Institute of Texas Grant # RP140020 , UTMB Clinical and Translational Science Award #UL1TR000071, NIH T-32 Grant # 5T32DK007639, and AHRQ Grant # 1R24HS022134.
- 11.Golcher, H., T.B. Brunner, H. Witzigmann, et al., Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: Results of the first prospective randomized phase II trial. Strahlenther Onkol, 2014.Google Scholar
- 17.Cooper, A.B., A.D. Parmar, T.S. Riall, et al., Does the Use of Neoadjuvant Therapy for Pancreatic Adenocarcinoma Increase Postoperative Morbidity and Mortality Rates? J Gastrointest Surg, 2014.Google Scholar
- 19.Herman, J.M., M.J. Swartz, C.C. Hsu, et al., Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol, 2008. 26(21): p. 3503-10.PubMedPubMedCentralCrossRefGoogle Scholar