Cancer Res Treat.  2018 Apr;50(2):562-574. 10.4143/crt.2017.105.

The Role of Consolidation Chemoradiotherapy in Locally Advanced Pancreatic Cancer Receiving Chemotherapy: An Updated Systematic Review and Meta-Analysis

Affiliations
  • 1National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan. hjmc@nhri.org.tw
  • 2Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
  • 3Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
  • 4Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • 5Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
  • 6Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.

Abstract

PURPOSE
The role of consolidation chemoradiation (CCRT) after systemic chemotherapy in locally advanced pancreatic cancer (LAPC) is still controversial. We aim to evaluate the effectiveness of CCRT in LAPC using systematic review and meta-analysis of prospective studies.
MATERIALS AND METHODS
Prospective clinical trials of LAPC receiving chemotherapy with or without subsequent CCRT were included in the analysis. We systematically searched in PubMed, MEDLINE, Embase, and Web of Science. The primary outcome of interest was 1-year survival. Secondary end-points were median overall survival, progression-free survival, toxicity, and resection rate.
RESULTS
Forty-one studies with 49 study arms were included with a total of 1,018 patients receiving CCRT after induction chemotherapy (ICT) and 954 patients receiving chemotherapy alone. CCRT after ICT did not improve 1-year survival significantly in LAPC patients compared with chemotherapy alone (58% vs. 52%). ICT lasted for at least 3 months revealed significantly improved survival of additional CCRT to LAPC patients compared to chemotherapy alone (65% vs. 52%). A marginal survival benefit of consolidation CCRT was noted in studies using maintenance chemotherapy (59% vs. 52%), and fluorouracil-based CCRT (64% vs. 52%), as well as in studies conducted after the 2010 (64% vs. 55%).
CONCLUSION
The survival benefit of ICT+CCRT over chemotherapy alone in treating LAPC was noted when ICT lasted for at least 3 months. Fluorouracil-based CCRT, and maintenance chemotherapy were associated with improved clinical outcomes.

Keyword

Pancreatic neoplasms; Adenocarcinoma; Induction chemotherapy; Chemoradiotherapy
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