There is no consensus on the management of locally advanced pancreatic cancer with either chemotherapy or combined modality approaches being employed.
No published meta-analysis has included randomized controlled trials employing radiation therapy.
|11 trials involving 794 patients were identified|
|British Journal of Cancer|
Dr Ghaneh and colleagues from England undertook a systematic review.
The research team compared chemoradiation followed by chemotherapy, a combined modality therapy, with best supportive care.
The team also compared radiotherapy with chemo radiation, and radiotherapy with combined modality therapy .
The team then compared chemotherapy with combined modality therapy.
In addition, 5-fluorouracil-based combined modality treatment was compared with another-agent-based combined modality therapy.
The researchers identified relevant trials by searching databases, trial registers and conference proceedings.
The primary end point was overall survival.
The team's secondary end points were progression-free survival/time-to-progression, response rate and adverse events.
Survival data were summarized using hazard ratio and response-rate to adverse-event data with relative risk.
The researchers identified 11 trials involving 794 patients that met the inclusion criteria.
The team found that length of survival with chemoradiation was increased compared with radiotherapy alone.
However, chemoradiation followed by chemotherapy did not lead to a survival advantage over chemotherapy alone.
The team was unable to perform meta-analyses for the other comparisons.
A survival benefit was demonstrated for chemoradiation over radiotherapy alone.
Dr Ghaneh's team concluded, “Chemoradiation followed by chemotherapy did not demonstrate any survival advantage over chemotherapy alone.”
“Important clinical differences cannot be ruled out due to the wide confidence interval.”