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Chemoradiotherapy versus chemotherapy for locally advanced unresectable pancreatic cancer: A systematic review and meta‐analysis
Author(s) -
Ng Ivy Weishan,
Soon Yu Yang,
Chen Desiree,
Tey Jeremy Chee Seong
Publication year - 2018
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12996
Subject(s) - medicine , hazard ratio , radiation therapy , meta analysis , chemoradiotherapy , confidence interval , oncology , randomized controlled trial , adverse effect , chemotherapy , pancreatic cancer , observational study , cancer
Purpose To determine the benefit of adding radiotherapy (RT) to chemotherapy for patients with locally advanced unresectable pancreatic cancer (LAUPC). Methods We searched MEDLINE for comparative studies comparing chemoradiotherapy with chemotherapy for patients with LAUPC. We performed the meta‐analysis with random effects model. The primary outcome was overall survival (OS); secondary outcomes include progression‐free survival (PFS) and adverse events (AE). Results We found five randomized (RCT) and three observational studies (OBS) including 830 patients. For RCTs, the addition of radiotherapy did not improve PFS (hazard ratio [HR] 0.90; 95% confidence interval [CI], 0.74–1.10; P = 0.30; I 2 = 11%,) or OS (HR 0.87; 95% CI, 0.63–1.21; P = 0.41; I 2 = 67%,) and was associated with increased grade 3 or 4 gastrointestinal AE. In contrast, OBS reported an improvement in PFS (HR 0.58; 95% CI, 0.37–0.92; P = 0.02; I 2 = 32%) and OS (HR 0.48; 95% CI, 0.35–0.60; P < 0.0001; I 2 = 6%). Conclusion The addition of radiotherapy did not improve the OS and PFS in RCTs. The divergence in results seen in OBS may be due to imbalance in baseline characteristics. Further research incorporating biomarkers may help to better select patients who will benefit from RT.