Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers
Purpose: Locally advanced pancreatic cancer (LAPC) treatment has varying practice patterns with poor outcomes. We investigated treatment using single-agent chemotherapy and multiagent chemotherapy (MAC) with or without radiation therapy (RT) at high-volume facilities (HVFs) and academic centers (ACs...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-04-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109418302318 |
| _version_ | 1819145483783766016 |
|---|---|
| author | John M. David, MD Sungjin Kim, MS Veronica R. Placencio-Hickok, PhD Arman Torosian, BS Andrew Hendifar, MD Richard Tuli, MD, PhD |
| author_facet | John M. David, MD Sungjin Kim, MS Veronica R. Placencio-Hickok, PhD Arman Torosian, BS Andrew Hendifar, MD Richard Tuli, MD, PhD |
| author_sort | John M. David, MD |
| collection | DOAJ |
| description | Purpose: Locally advanced pancreatic cancer (LAPC) treatment has varying practice patterns with poor outcomes. We investigated treatment using single-agent chemotherapy and multiagent chemotherapy (MAC) with or without radiation therapy (RT) at high-volume facilities (HVFs) and academic centers (ACs). Methods and Materials: The National Cancer Database was used to obtain data on 10,139 patients with LAPC. HVF was defined as the top 5% of facilities per number of patients treated at each facility. Univariate and multivariable (MVA) analysis Cox regressions were performed to identify the impact of HVF, AC, MAC, and RT on overall survival (OS). Results: The median age of patients was 66 years (range, 22-90); 50.1% were male and 49.9% female. Of the patients, 46.1% received MAC, 53.8% received single-agent chemotherapy, 45.7% received RT, 54.3% did not receive RT, and 5% underwent surgical resection. The median follow-up was 48.8 months. On MVA, treatment at HVFs and ACs remained significantly associated with improved OS, with a hazard ratio (HR) of 0.84 (P < .001) and 0.94 (P = .004), respectively. The median OS for HVF treatment compared with low-volume facilities was 14.3 versus 11.2 months, respectively (P < .001). The median OS for AC treatment versus non-AC was 12.1 versus 10.8 months, respectively (P < .001). Additionally, on MVA, receipt of RT and MAC remained significantly associated with improved OS (HR: 0.76; P < .001; and HR: 0.73; P < .001, respectively). MVA for receipt of surgery showed that MAC is a significant predictor for receiving surgery (odds ratio: 1.29; P = .009). Conclusions: Our results build on a growing literature supporting RT and MAC in treating LAPC. Additionally, we believe that—in the absence of prospective data—this makes a strong case for considering MAC with RT at ACs and HVFs for treating LAPC. |
| first_indexed | 2024-12-22T12:58:45Z |
| format | Article |
| id | doaj.art-722c83ef6583400cab20bfe3d42179e9 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-22T12:58:45Z |
| publishDate | 2019-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-722c83ef6583400cab20bfe3d42179e92022-12-21T18:25:02ZengElsevierAdvances in Radiation Oncology2452-10942019-04-0142302313Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centersJohn M. David, MD0Sungjin Kim, MS1Veronica R. Placencio-Hickok, PhD2Arman Torosian, BS3Andrew Hendifar, MD4Richard Tuli, MD, PhD5Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CaliforniaDepartment of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California; Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CaliforniaDepartment of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CaliforniaDepartment of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CaliforniaSamuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CaliforniaDepartment of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California; Corresponding author. Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048.Purpose: Locally advanced pancreatic cancer (LAPC) treatment has varying practice patterns with poor outcomes. We investigated treatment using single-agent chemotherapy and multiagent chemotherapy (MAC) with or without radiation therapy (RT) at high-volume facilities (HVFs) and academic centers (ACs). Methods and Materials: The National Cancer Database was used to obtain data on 10,139 patients with LAPC. HVF was defined as the top 5% of facilities per number of patients treated at each facility. Univariate and multivariable (MVA) analysis Cox regressions were performed to identify the impact of HVF, AC, MAC, and RT on overall survival (OS). Results: The median age of patients was 66 years (range, 22-90); 50.1% were male and 49.9% female. Of the patients, 46.1% received MAC, 53.8% received single-agent chemotherapy, 45.7% received RT, 54.3% did not receive RT, and 5% underwent surgical resection. The median follow-up was 48.8 months. On MVA, treatment at HVFs and ACs remained significantly associated with improved OS, with a hazard ratio (HR) of 0.84 (P < .001) and 0.94 (P = .004), respectively. The median OS for HVF treatment compared with low-volume facilities was 14.3 versus 11.2 months, respectively (P < .001). The median OS for AC treatment versus non-AC was 12.1 versus 10.8 months, respectively (P < .001). Additionally, on MVA, receipt of RT and MAC remained significantly associated with improved OS (HR: 0.76; P < .001; and HR: 0.73; P < .001, respectively). MVA for receipt of surgery showed that MAC is a significant predictor for receiving surgery (odds ratio: 1.29; P = .009). Conclusions: Our results build on a growing literature supporting RT and MAC in treating LAPC. Additionally, we believe that—in the absence of prospective data—this makes a strong case for considering MAC with RT at ACs and HVFs for treating LAPC.http://www.sciencedirect.com/science/article/pii/S2452109418302318 |
| spellingShingle | John M. David, MD Sungjin Kim, MS Veronica R. Placencio-Hickok, PhD Arman Torosian, BS Andrew Hendifar, MD Richard Tuli, MD, PhD Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers Advances in Radiation Oncology |
| title | Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers |
| title_full | Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers |
| title_fullStr | Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers |
| title_full_unstemmed | Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers |
| title_short | Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers |
| title_sort | treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high volume facilities and academic centers |
| url | http://www.sciencedirect.com/science/article/pii/S2452109418302318 |
| work_keys_str_mv | AT johnmdavidmd treatmentstrategiesandclinicaloutcomesoflocallyadvancedpancreaticcancerpatientstreatedathighvolumefacilitiesandacademiccenters AT sungjinkimms treatmentstrategiesandclinicaloutcomesoflocallyadvancedpancreaticcancerpatientstreatedathighvolumefacilitiesandacademiccenters AT veronicarplacenciohickokphd treatmentstrategiesandclinicaloutcomesoflocallyadvancedpancreaticcancerpatientstreatedathighvolumefacilitiesandacademiccenters AT armantorosianbs treatmentstrategiesandclinicaloutcomesoflocallyadvancedpancreaticcancerpatientstreatedathighvolumefacilitiesandacademiccenters AT andrewhendifarmd treatmentstrategiesandclinicaloutcomesoflocallyadvancedpancreaticcancerpatientstreatedathighvolumefacilitiesandacademiccenters AT richardtulimdphd treatmentstrategiesandclinicaloutcomesoflocallyadvancedpancreaticcancerpatientstreatedathighvolumefacilitiesandacademiccenters |