Combined radiochemotherapy in patients with locally advanced pancreatic cancer: a meta-analysis

Abstract

Aim: To compare the long-term clinical efficacy of chemotherapy plus radiotherapy (CRT) with that of radiotherapy alone (RT) or chemotherapy alone (CT) for locally advanced pancreatic carcinoma (LAPC).

Methods: Using manual and computer-aided methods, we searched the data through the databases, including PubMed/EmBase/CNKI/CQVIP/China Journals Full Text Database and websites and proceedings of major annual meetings such as ASCO and CSCO. The methodological quality of the included studies was assessed using the Jadad scoring system. Both English and Chinese publications were searched. We collected data from controlled clinical trials on CRT vs RT or CT for LAPC, and conducted a meta-analysis of 15 included studies. Meta-analysis was performed using RevMan4.2 Software according to the method recommended by Cochrane Collaboration.

Results: Fifteen eligible randomized controlled trials including a total of 1128 patients were screened. Jadad score was 2 in only one article, and 3-4 in the remaining 14 studies. The meta-analysis showed that CRT was superior in the 6- and 12-mo survivals to the RT alone group or CT alone group (P = 0.0001 and P = 0.02, respectively), whereas the 18-mo survival showed no significant difference (P = 0.23). Subgroup analysis showed that the 6-, 12-, and 18-mo survivals were not significantly different between the CRT group and CT group (P = 0.07, P = 0.23, and P = 0.91, respectively). Notably, the CRT group had significantly better 6-, 12-, and 18-mo survivals than the RT group (all P < 0.01). CRT group had significantly more grade 3-4 treatment-related hematologic and non-hematologic toxicities than the CT group or RT group (all P < 0.01).

Conclusion: Compared with CT or RT, CRT can benefit the long-term survival of LAPC patients, although it may also increase treatment-related toxicities.

Keywords: Chemotherapy; Meta-analysis; Pancreatic cancer; Radiotherapy; Survival.

Figure 1

Flow diagram depicting the process of identification and inclusion of selected studies. RCT: Randomized controlled trials.

Figure 2

Meta-analysis. A: On chemotherapy plus radiotherapy (CRT) vs chemotherapy alone (CT)/radiotherapy alone (RT) for locally advanced pancreatic carcinoma (LAPC) in the 6-, 12-, and 18-mo survivals; B: On CRT vs CT for LAPC in the 6-, 12-, and 18-mo survivals; C: On CRT vs RT for LAPC in the 6-, 12-, and 18-mo survivals; D: On CRT > 50 Gy vs RT for LAPC in the 12-mo survivals; E: On CRT < 50 Gy vs RT for LAPC in the 6- and 12-mo survivals; F: On CRT vs CT/RT for LAPC in grade 3-4 treatment-related toxicities.