Patterns of care in pancreatic cancer radiotherapy: impact of facility volume on outcomes

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- (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