TY - JOUR
T1 - Contemporary use and outcomes of radiation and chemotherapy for unresectable pancreatic cancer
AU - Moningi, Shalini
AU - Lei, Xiudong
AU - Fang, Penny
AU - Taniguchi, Cullen M.
AU - Holliday, Emma B.
AU - Koay, Eugene J.
AU - Koong, Albert C.
AU - Ludmir, Ethan B.
AU - Minsky, Bruce D.
AU - Das, Prajnan
AU - Giordano, Sharon H.
AU - Smith, Grace L.
N1 - Funding Information:
This research was supported by the MD Anderson Cancer Center grant P30 CA016672.
Funding Information:
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. SHG reports research funding from CPRIT, Komen. Dr. PD reports payment or honoraria from Adlai Nortye, ASTRO, ASCO, Leidos/NCI, Conveners LLC, Physicians Education Resource. Dr. GLS reports research funding from NIH. Dr. EBL reports research funding from the Fund for Innovation in Cancer Informatics. Dr. EJK reports research funding from the Department of Defense, NIH, Philips, Elekta, GE Healthcare, Siemens, EMD Serono; royalties from Taylor and Francis, LLC; consulting for RenovoRx, Augmenix, MD Anderson Physicians Network and equity ownership in Quantum Aurea. Dr. CT reports research funding from NIH, Mark Foundation, V Foundation, Galera Therapeutics, 4D Therapeutics, Patent licensed by Xerient, consult fees from Phebry Ltd, and Xerient, and patent issued for radioprotection of the intestines. Data used in this study was accessed from the SEER database and Texas cancer registry linked to the Medicare database.
Publisher Copyright:
© 2022
PY - 2022/7
Y1 - 2022/7
N2 - Background: We assessed radiation treatment (RT) use and complications for unresectable pancreatic cancer in the US, comparing conventionally fractionated (CFRT) and stereotactic body radiation treatment (SBRT) to inform real-world expected outcomes and practice. Material and Methods: We analyzed 5,624 patients with non-metastatic, unresectable pancreatic cancer (2,522 older patients age > 65, diagnosed 2006–2013 in Medicare linked data; and 3,102 younger patients age < 65, diagnosed 2006–2016 in MarketScan data), comparing CFRT vs. SBRT vs. chemotherapy alone. Cochran-Armitage tested temporal trends. Fisher's Exact Test and proportional hazards models compared gastrointestinal (GI) complications. Healthcare payments (Consumer Price Index adjusted to 2015) through 12 months were compared using generalized linear regression models with log link and gamma distribution. Results: RT use declined from 55% to 45% of older patients (2006–2013) and 52% to 47% of younger patients (2006–2016) (Ptrend < 0.001 both). Among RT patients, SBRT use increased to 10% of older patients and 12% of younger patients in the most recent years (Ptrend = 0.04 and < 0.001 respectively). Addition of RT was associated with more frequent GI bleeds, strictures, and fistulas (Δ= +3% to 9% excess events, all P ≤ 0.05). Temporal patterns suggested decreasing complications over time (Ptrend = 0.05 and 0.05 for older and younger patients). Among younger patients, there was no difference in GI complications for SBRT vs. CFRT (P > 0.05, all comparisons). Among older patients, increased complications were seen for SBRT in 1–4 fractions vs. CFRT (P < 0.05), but not SBRT in 5 fractions (P = 0.72). Healthcare payments were greatest for SBRT when compared with CFRT or chemotherapy under US Medicare (P < 0.001) and employer-based insurance (P < 0.001). Conclusion: Real-world treatment has shifted toward more selectivity for RT in unresectable pancreatic cancer. However, SBRT uptake and improving trends in complications profiles represent opportunities to optimize current use and benefit. Findings are applicable to inform future comparative and cost effectiveness models of RT for this disease.
AB - Background: We assessed radiation treatment (RT) use and complications for unresectable pancreatic cancer in the US, comparing conventionally fractionated (CFRT) and stereotactic body radiation treatment (SBRT) to inform real-world expected outcomes and practice. Material and Methods: We analyzed 5,624 patients with non-metastatic, unresectable pancreatic cancer (2,522 older patients age > 65, diagnosed 2006–2013 in Medicare linked data; and 3,102 younger patients age < 65, diagnosed 2006–2016 in MarketScan data), comparing CFRT vs. SBRT vs. chemotherapy alone. Cochran-Armitage tested temporal trends. Fisher's Exact Test and proportional hazards models compared gastrointestinal (GI) complications. Healthcare payments (Consumer Price Index adjusted to 2015) through 12 months were compared using generalized linear regression models with log link and gamma distribution. Results: RT use declined from 55% to 45% of older patients (2006–2013) and 52% to 47% of younger patients (2006–2016) (Ptrend < 0.001 both). Among RT patients, SBRT use increased to 10% of older patients and 12% of younger patients in the most recent years (Ptrend = 0.04 and < 0.001 respectively). Addition of RT was associated with more frequent GI bleeds, strictures, and fistulas (Δ= +3% to 9% excess events, all P ≤ 0.05). Temporal patterns suggested decreasing complications over time (Ptrend = 0.05 and 0.05 for older and younger patients). Among younger patients, there was no difference in GI complications for SBRT vs. CFRT (P > 0.05, all comparisons). Among older patients, increased complications were seen for SBRT in 1–4 fractions vs. CFRT (P < 0.05), but not SBRT in 5 fractions (P = 0.72). Healthcare payments were greatest for SBRT when compared with CFRT or chemotherapy under US Medicare (P < 0.001) and employer-based insurance (P < 0.001). Conclusion: Real-world treatment has shifted toward more selectivity for RT in unresectable pancreatic cancer. However, SBRT uptake and improving trends in complications profiles represent opportunities to optimize current use and benefit. Findings are applicable to inform future comparative and cost effectiveness models of RT for this disease.
KW - Complications
KW - Cost
KW - Gastrointestinal
KW - Pancreatic cancer
KW - SBRT
KW - Stereotactic body radiation treatment
KW - Toxicity
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U2 - 10.1016/j.ctro.2022.04.007
DO - 10.1016/j.ctro.2022.04.007
M3 - Article
C2 - 35510142
AN - SCOPUS:85129516373
SN - 2405-6308
VL - 35
SP - 9
EP - 16
JO - Clinical and Translational Radiation Oncology
JF - Clinical and Translational Radiation Oncology
ER -