Nonsurgical therapies for resected and unresected pancreatic cancer in Europe and USA in 2003–2014: a large international population‐based study

• Published in: International journal of cancer Vol. 143; no. 12; pp. 3227 - 3239
• Main Authors: Huang, Lei, Jansen, Lina, Balavarca, Yesilda, Geest, Lydia, Lemmens, Valery, Van Eycken, Liesbet, De Schutter, Harlinde, Johannesen, Tom B., Primic‐Žakelj, Maja, Zadnik, Vesna, Mägi, Margit, Pulte, Dianne, Schrotz‐King, Petra, Brenner, Hermann
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15.12.2018; Wiley Subscription Services, Inc
• Subjects: Cancer; Cancer therapies; Chemotherapy; Data processing; Demographics; Epidemiology; Europe; Geographical variations; Medical research; nonsurgical therapies; Pancreatic cancer; Patients; Population studies; Population-based studies; population‐based; Radiation; Radiation therapy; Standardization; USA; Belgium; United States > US; Europe; USA; pancreatic cancer; nonsurgical therapies; Europe; population-based
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.31628

The role of chemotherapy in the treatment of pancreatic cancer (PaC) has been well‐established, while radiation plays ambiguous roles. This international large‐scale population‐based study aimed to investigate the real‐world application of chemotherapy and radiotherapy for resected and unresected PaC in Europe and USA. Population‐based data from multiple European national cancer registries and the US Surveillance, Epidemiology and End Results (SEER)‐18 database during 2003–2014 were analyzed. Temporal trends and geographical variations in the application rates of chemotherapy and radiotherapy were quantified using age standardization. Associations of treatment with demographic and clinical characteristics were assessed using multivariable logistic regression. A total of 141,533 PaC patients were analyzed. From 2003–2005 to 2012–2014, chemotherapy administration rates increased in most countries and more strongly among resected patients, while radiation rates were generally low with a slight decline or no obvious trend. In 2012–2014, 12.5% (Estonia) to 61.7% (Belgium) of resected and 17.1% (Slovenia) to 56.9% (Belgium) of unresected patients received chemotherapy. Radiation was administered in 2.6% (Netherlands) to 32.6% (USA) of resected and 1.0% (USA) to 6.0% (Belgium) of unresected patients. Strong temporal and geographical variations were observed. Patterns and strengths of associations of treatment administration with various demographic and clinical factors differed substantially between resected and unresected cancers and varied greatly across countries. Conclusively, administration of chemotherapy but not radiotherapy for PaC increased during the last decade in Europe and USA. Treatment rates were low and the uptake strongly varied across countries, highlighting the need for standardization in PaC treatment to improve patient care. What's new? The use of combination chemotherapy after tumor resection is associated with improved overall survival in pancreatic cancer. Chemotherapy can be further used alongside radiotherapy, though the extent to which this approach is employed for pancreatic cancer is uncertain. In this international population‐based study of pancreas cancer cases diagnosed from 2003–2014, chemotherapy use was found to increase in most countries, most notably for resected pancreatic cancer. Meanwhile, radiotherapy use was low. Associations between treatment and clinicopathologic factors varied according to resection and country. The findings highlight a possible need for treatment standardization to improve care for pancreatic cancer patients.