Radiation for pancreatic cancer varies by hospital

By Amy Norton

NEW YORK (Reuters Health) - The odds of receiving radiation therapy for pancreatic cancer may depend on whether a patient's hospital has its own radiation facilities, a new study suggests.

While radiation is commonly used against many cancers, it's unclear whether the therapy is effective for pancreatic cancer, a particularly lethal disease. So the decision of whether to try the treatment is not clear-cut.

The new findings, published in the journal Cancer, suggest that much may depend on whether the hospital has on-site radiation facilities.

Among 714 Americans treated for pancreatic cancer between 1992 and 1999, those who underwent surgery at centers with their own radiation services were twice as likely to receive this additional treatment.

The study found no such disparity, however, among more than 9,000 people treated during the same period for rectal cancer, a cancer for which evidence clearly supports the effectiveness of radiation therapy.

Given the uncertainty about radiation for pancreatic cancer, it's not clear whether the findings mean that some patients are missing out on a potentially helpful therapy or if radiation is being overused at some centers.

"This begs the question of whether it's overused or underused," said lead study author Dr. Sandra L. Wong of the University of Michigan, Ann Arbor.

"What's unknown is the appropriate rate," she told Reuters Health.

There have been four rigorous clinical trials looking at radiation for pancreatic cancer, with mixed results. So the therapy is still "fairly controversial" when it comes to this disease, Wong said.

Cancer specialists who work in hospitals with radiation services may be "more enthusiastic" about trying it for pancreatic tumors, according to the Wong.

She and her colleagues based their findings on government data for more than 10,000 Medicare recipients who underwent surgery for pancreatic or rectal cancer.

Among those with rectal cancer, 29 percent treated at hospitals with on-site radiation facilities underwent this therapy after surgery -- as did 29 percent of patients who had surgery at hospitals without their own radiation services.

Among pancreatic cancer patients, however, those figures were 43 percent and 26 percent, respectively.

What's needed now, Wong said, are more clinical trials investigating the role of radiation therapy in pancreatic cancer. Until then, she noted, it will be unclear whether some patients are missing out on an effective therapy or undergoing therapy that is unlikely to improve their survival rate.

SOURCE: Cancer, February 15, 2007.