Impact of Institutional Radiotherapy Patient Volume on Postoperative and Oncologic Outcomes After Neoadjuvant Radiation for Pancreatic Cancer.

INTRODUCTION: Neoadjuvant radiation therapy (NRT) is beneficial in gastrointestinal cancers, but its role in pancreatic ductal adenocarcinoma (PDAC) remains uncertain. It is unclear if hospital-level NRT volume is an important factor when treating PDAC with NRT. METHODS: The National Cancer Database (2011-2019) was used to identify PDAC patients who received NRT followed by surgical resection. Hospital NRT volume was defined in two ways: mean annual number of patients treated for (1) PDAC and (2) esophageal/rectal cancers. Hospitals were categorized as low (<90th percentile) or high (≥90th percentile) volume. Multivariable logistic regression and Cox proportional hazards models evaluated associations between hospital NRT volume, overall survival (OS), 30-day readmission, and surgical margin status. RESULTS: Among 2879 PDAC patients, receiving NRT at low-volume hospitals was associated with lower OS (esophageal/rectal cancer NRT hospital volume, HR 1.16, 95% CI 1.05-1.29, p = 0.005; PDAC NRT hospital volume, HR 1.25, 95% CI 1.11-1.41, p < 0.001). Annual average patient volume of NRT for PDAC at the hospital level as a continuous variable was associated with a decrease in the adjusted log odds of 30-day readmissions and positive surgical margins. CONCLUSIONS: Higher institutional NRT volume was associated with higher OS and lower 30-day readmissions and positive surgical margins among PDAC patients.