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Effect of chemoradiotherapy and neoadjuvant chemoradiotherapy in resectable pancreatic cancer: a systematic review and meta-analysis

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Abstract

Objective

Controversy remains existed whether chemoradiotherapy (CRT), especially neoadjuvant chemoradiotherapy (neoadjuvant CRT) achieves a significant benefit in resectable pancreatic cancer (PC) treatment. In this meta-analysis, we aimed to clarify the benefits of CRT and neoadjuvant CRT in resectable PC.

Methods

Eligible trials were identified from MEDLINE, EMBASE, Cochrane center, China National Knowledge Internet and Wanfang database since their inception to July 31, 2013. Only patients with resectable PC, who underwent tumor resection and received CRT and/or neoadjuvant CRT, were enrolled. The treatment outcomes were overall survival (OS) and progression-free survival (PFS). Hazard ratio (HR) with a 95 % confidence interval (CI) was used to measure the pooled effect according to a fixed-effects model. The statistical heterogeneity between trials was detected by χ2 and I 2 test. Sensitivity analyses were also carried out.

Results

A total of 28 studies were identified as relevant, but only 17 studies with a total of 3,088 patients were included in the comparison between CRT versus non-CRT, and a total number of three studies with 189 patients included in the comparison between neoadjuvant CRT versus postoperative CRT. The comparison between CRT and non-CRT showed that the overall pooled HR for death was 0.96 (95 % CI 0.89–1.03; P = 0.28). The HR for progress was 0.83 (95 % CI 0.68–1.03, P = 0.09). Comparison between neoadjuvant CRT and adjuvant CRT revealed a pooled HR of 0.93 (95 % CI 0.69–1.25; P = 0.62).

Conclusions

This meta-analysis showed that CRT showed no significant effect on OS and PFS when compared to non-CRT. Neoadjuvant CRT showed no significant effect over postoperative adjuvant CRT.

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Acknowledgments

This work was supported by the Nature Science Foundation of Shandong Province (ZR2012HM095).

Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of the manuscript entitled.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Affiliated Qianfoshan Hospital, Shandong University, Jinan, China

    C. P. Xu

  2. Department of Radiation Oncology, Shandong University School of Medicine, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China

    X. J. Xue, D. G. Xu, F. J. Liu, X. S. Yu & J. D. Zhang

  3. Division of Oncology, Department of Graduate, Weifang Medical College, Weifang, Shandong, China

    N. Liang

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  1. C. P. Xu
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Correspondence to J. D. Zhang.

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Xu, C.P., Xue, X.J., Liang, N. et al. Effect of chemoradiotherapy and neoadjuvant chemoradiotherapy in resectable pancreatic cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 140, 549–559 (2014). https://doi.org/10.1007/s00432-013-1572-4

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