Open AccessNeoadjuvant therapy in pancreatic cancer: a systematic review and meta‐analysis of prospective studies
Author(s) -
Zhan HanXiang,
Xu JianWei,
Wu Dong,
Wu ZhiYang,
Wang Lei,
Hu SanYuan,
Zhang GuangYong
Publication year - 2017
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1071
Subject(s) - medicine , neoadjuvant therapy , radiation therapy , meta analysis , pancreatic cancer , oncology , chemotherapy , prospective cohort study , cancer , surgery , breast cancer
Abstract There is a strong rationale and many theoretical advantages for neoadjuvant therapy in pancreatic cancer ( PC ). However, study results have varied significantly. In this study, a systematic review and meta‐analysis of prospective studies were performed in order to evaluate safety and effectiveness of neoadjuvant therapy in PC . Thirty‐nine studies were selected ( n = 1458 patients), with 14 studies focusing on patients with resectable disease (group 1), and 19 studies focusing on patients with borderline resectable and locally advanced disease (group 2). Neoadjuvant chemotherapy was administered in 97.4% of the studies, in which 76.9% was given radiotherapy and 74.4% administered with chemoradiation. The complete and partial response rate was 3.8% and 20.9%. The incidence of grade 3/4 toxicity was 11.3%. The overall resection rate after neoadjuvant therapy was 57.7% (group 1: 73.0%, group 2: 40.2%). The R0 resection rate was 84.2% (group 1: 88.2%, group 2: 79.4%). The overall survival for all patients was 16.79 months (resected 24.24, unresected 9.81; group 1: 17.76, group 2: 16.20). Our results demonstrate that neoadjuvant therapy has not been proven to be beneficial and should be considered with caution in patients with resectable PC . Patients with borderline resectable or locally advanced disease may benefit from neoadjuvant therapy, but further research is needed.