Title : Meta-analysis of neoadjuvant chemoradiotherapy versus chemotherapy in patients with pancreatic ductal adenocarcinoma: A level 1a evidence
Abstract:
Aims: To evaluate comparative outcomes of neoadjuvant chemoradiotherapy (NACR) and neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC).
Methods: Systematic search of electronic data sources was conducted and all randomised controlled trials (RCTs) investigating outcomes of NACR and NAC in patients with PDAC were considered. Surgical resection rate, R0 resection, radiological response to treatment, and 1- to 5-years survival were the evaluated outcome measures.
Results: Twenty-four RCTs reporting a total of 2273 patients who received NACR (n=1152) and NAC (n=1121) for PDAC were included. Both NACR and NAT were associated with comparable rate of partial response [11.8% (95% CI 3.9%-19.8%) vs 20.1% (95% CI 11.7%-28.6%)], stable disease [41.2% (95% CI 28.0%-54.5%) vs 47.1%(95% CI 30.3%-63.8%)], or disease progression [17.3% (95%CI 4.1%-30.5%) vs 25.2% (95% CI 12.6%-37.9%)] during treatment. The comparative meta-analyses demonstrated that there was no significant difference in surgical resection rate (68.9% vs. 71.5%, OR 0.96; 95%CI: 0.89–1.05, p=0.39), R0 resection (70.7% vs. 64.2%, OR 1.04; 95%CI: 0.90–1.20, p=0.58), 1-year (71.3% vs. 72.4%, OR 0.99; 95%CI: 0.81–1.20, p=0.90) and 3-years survival (21.9% vs. 21.4%, OR 0.93; 95%CI: 0.68–1.29, p=0.68) between NACR and NAC. Sub-group analyses on resectable or borderline resectable PDAC were consistent with the main analyses.
Conclusions: The meta-analysis of best available evidence (level 1a) demonstrates that NACR and NAC are associated with comparable surgical resection rate, R0 resection, and survival in patients with PDAC. The available evidence may be subject to type 2 error and future randomised evidence is needed.
