Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.155
Peer-review started: November 14, 2022
First decision: November 24, 2022
Revised: November 27, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 15, 2023
Processing time: 57 Days and 4 Hours
Pancreatic ductal adenocarcinoma (PDAC) is primarily a disease of the elderly, with a median age at diagnosis of 70 years. Elderly patients represent a unique subgroup of the cancer patient population, for which the role of cancer therapy requires special consideration.
Radiation therapy (RT) plays an evolving and pivotal role in providing optimal care for patients with PDAC. However, studies evaluating the use and effectiveness of RT for treating PDAC in older patients are scarce.
To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.
Data from patients with PDAC aged ≥ 65 years between 2004 and 2018 were collected from the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was performed to determine factors associated with RT administration. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS. Propensity score matching (PSM) was applied to balance the baseline characteristics between the RT and non-RT groups. Subgroup analyses were performed based on clinical characteristics.
A total of 12245 patients met the inclusion criteria, with 2551 (20.8%) patients who were treated with RT and 9694 (79.2%) who were not. The odds of receiving RT increased with younger age, diagnosis in the earlier period, primary site in the head, localized disease, greater tumor size, and receiving chemotherapy (all P < 0.05). Before PSM, the RT group had better outcomes than did the non-RT group [median OS: 14.0 vs 6.0 mo; hazard ratio (HR) for OS: 0.862, 95% confidence interval (CI): 0.819–0.908, P < 0.001; and HR for CSS: 0.867, 95%CI: 0.823–0.914, P < 0.001]. After PSM, the survival benefit associated with RT remained comparable (median OS: 14.0 vs 11.0 mo; HR for OS: 0.818, 95%CI: 0.768–0.872, P < 0.001; and HR for CSS: 0.816, 95%CI: 0.765–0.871, P < 0.001). Subgroup analysis revealed that the survival benefits (OS and CSS) of RT were more significant in patients aged 65 to 80 years, in regional and distant stages, with no surgery, and receiving chemotherapy.
The current study demonstrated that elderly PDAC patients who were treated with RT had improved OS and CSS when compared to those patients who were not treated with RT.
This study adds to the growing literature on retrospective studies on the role of RT in elderly patients with PDAC and highlights the need for a large multicenter randomized trial to further understand this subject.