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. 2022 Nov 23:12:979390.
doi: 10.3389/fonc.2022.979390. eCollection 2022.

Is neoadjuvant chemoradiotherapy for pancreatic cancer beneficial: A systematic review and meta-analysis

Wenhao Luo  1 , Yawen Wang  2 , Yinjie Tao  2 , Taiping Zhang  1
Affiliations

Is neoadjuvant chemoradiotherapy for pancreatic cancer beneficial: A systematic review and meta-analysis

Wenhao Luo et al. Front Oncol. .

Abstract

To examine the potential benefits and adverse events of neoadjuvant Chemoradiotherapy (CRT) versus upfront surgery in pancreatic cancer (PC) patients. Extensive librarian-led literature searches were conducted on PubMed, Web-of-Science, Scopus, Google Scholar, the Cochrane Central Library and Embase. The primary outcomes were resectability, adverse events, pathological and survival outcomes. Five studies, including 437 participants, were analyzed. Upfront surgery had a significantly higher resectability among PC patients than neoadjuvant CRT group (Odds ratio = -0.11, 95% CI = -0.19-0.02, P = 0.01). The neoadjuvant CRT group had a comparatively higher Ro resection rate (OR = 3.38, 95% CI = 2.03-5.62, P < 0.01), fewer severe adverse events(OR = 0.56, 95% CI = 0.34-0.92, P = 0.02), lower positive LN rate(OR = 0.18, 95% CI = 0.11-0.31, P < 0.01) and higher 2-year OS(OR = 1.60, 95% CI = 1.02-2.52, P = 0.04) among PC patients than control group. There was no significant difference between neoadjuvant CRT and upfront surgery among PC patients on postoperative complications(OR = 1.49, 95% CI = 0.86-2.57, P = 0.16), metastasis rate(OR = 1.32, 95% CI = 0.42-4.18, P = 0.64) and 1-year OS(OR = 1.30, 95% CI = 0.85-1.98, P = 0.22). This systematic review confirmed the status of neoadjuvant CRT in the PC treatment. The neoadjuvant CRT could increase the R0 resection rate, which was important to the survival and life quality of patients. The specific choice of various neoadjuvant CRT therapy needs to be further studied. Individualized neoadjuvant therapy should be suitable for each patient, and patients with PC are best managed by a multidisciplinary team.

Keywords: adverse events; complication events; neoadjuvant CRT; overall survival; upfront surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the bibliographic search.
Figure 2
Figure 2
Meta-analysis of study on resectability and adverse events outcomes. Forest plot of (A) Resectability; (B) R0 rate; (C) Severe adverse events; (D) postoperative complications.
Figure 3
Figure 3
Meta-analysis of study on pathological and survival outcomes. Forest plot of (A) positive lymph node rate; (B) metastasis rate; (C) 1-year OS; (D) 2-year OS.
Figure 4
Figure 4
Funnel plot of outcomes.s. (A) Resectability; (B) R0 rate; (C) Severe adverse events; (D) postoperative complications, (E) positive lymph node rate; (F) metastasis rate; (G) 1-year OS; (H) 2-year OS.
See this image and copyright information in PMC

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