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Survival benefit of particle chemoradiotherapy in locally advanced unresectable pancreatic cancer: a systematic review and meta-analysis
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DOI：10.1177/17562848261465516.png)
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Abstract
En 中文
<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>The pros and cons of incorporating radiotherapy (RT) into chemotherapy (CT) for locally advanced unresectable pancreatic cancer (LAPC) have been debated for decades. Recently, particle (proton and carbon-ion) therapy has emerged as a new radiotherapy modality. Given the unclear benefits of this approach, we summarized clinical outcomes of LAPC treated with concurrent chemoradiotherapy (CRT) using particle therapy to compare outcomes with current treatments.</jats:p>
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<jats:title>Objectives:</jats:title>
<jats:p>To evaluate the efficacy and safety of particle therapy-based CRT in patients with LAPC and compare survival outcomes with photon CRT, combination CT, and single-agent CT.</jats:p>
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<jats:sec>
<jats:title>Design:</jats:title>
<jats:p>Systematic review and single-arm meta-analysis.</jats:p>
</jats:sec>
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<jats:title>Data sources and methods:</jats:title>
<jats:p>Studies evaluating LAPC treated with first-line particle CRT, photon CRT, combination CT, and single-agent CT were included. A single-arm meta-analysis was performed to calculate a pooled effect size using the DerSimonian and Laird random-effects model. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), response rate, and adverse events.</jats:p>
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<jats:title>Results:</jats:title>
<jats:p>Across 42 studies and 3161 patients with LAPC, particle CRT achieved a pooled 1-year OS of 75.8% (95% confidence interval (CI) 71.3–79.7), 2-year OS of 41.3% (95% CI 35.6–47.3), and 1-year PFS of 51.7% (95% CI 43.2–60.0). Photon CRT achieved a 1-year OS of 59.4% and 2-year OS of 21.0%; combination chemotherapy 64.4% and 30.8%; and single-agent chemotherapy 37.2% and 13.1%. Pooled response rate after particle CRT was 48.8%. Grade ⩾3 upper gastrointestinal events (ulcer/bleeding) were more frequent after particle CRT (4.3%) than after photon CRT (2.1%).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion:</jats:title>
<jats:p>Particle therapy CRT might have comparable survival outcomes in treating LAPC with combination CT, photon CRT, and single-agent CT. These findings support considering particle CRT as a valuable first-line treatment option for LAPC, which should be validated in randomized clinical trials.</jats:p>
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<jats:title>Trial registration:</jats:title>
<jats:p>The final search was conducted on December 31, 2024. The review protocol was registered in PROSPERO with the registration number CRD42023493665.</jats:p>
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