ORIGINAL RESEARCH article
Front. Oncol.
Sec. Radiation Oncology
Patterns of care in pancreatic cancer radiotherapy: impact of facility volume on outcomes
Provisionally accepted
- 1The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, United States
- 2Icahn School of Medicine at Mount Sinai, New York, United States
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Objectives: Radiotherapy (RT), particularly stereotactic body radiotherapy (SBRT), is a promising treatment for borderline resectable or locally advanced pancreatic cancer (PC). This study evaluated the association of RT facility volume with overall survival (OS) and examined patterns of care for patients with PC. Methods: A retrospective cohort study using National Cancer Database (NCDB) data (2004-2019) included 17,053 PC patients treated with RT, excluding those with metastatic or stage IV disease. RT facility volumes were categorized as low- (<10 cases/year), intermediate- (10-20 cases/year), and high-volume (>20 cases/year). Predictors of OS, including facility volume, RT type, and patient/treatment factors, were evaluated. Results: Among 17,053 patients (median age 67 years, 51.4% male), 17.6% received SBRT, and 27.1% were treated at high-volume centers. Treatment at high-volume centers (HR 0.863, p<0.001) and receiving SBRT (HR 0.869, p<0.001) were associated with improved OS. SBRT use increased from 8.5% (2004-2011) to 30% (2016-2019). Conclusion: High-volume RT centers are associated with significantly better survival outcomes in PC patients, particularly those receiving SBRT. These findings emphasize the need to expand access to high-volume centers and develop standardized treatment protocols to improve care and outcomes for all patients.
Keywords: Radiotherapy, Pancreatic Cancer, Stereotactic body radiotherapy (SBRT), facility volume, Overall survival (OS)
Received: 26 Jun 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Rajan, Gleeson, Pham and Goodman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Arvind Rajan, arvind_rajan@med.unc.edu
Karyn Goodman, karyn.goodman@mountsinai.org
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