Neoadjuvant Chemoradiotherapy Versus Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-analysis of Randomised Controlled Trials.
Shahin Hajibandeh, Shahab Hajibandeh, Jameel Alfarah et al.
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In 30 seconds
This systematic review and meta-analysis of randomised controlled trials compared neoadjuvant chemoradiotherapy (NACR) with neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma. It included 24 trials and 2273 patients. The pooled analyses found no significant differences in surgical resection rate (68.9% vs. 71.5%; OR 0.96; 95% CI 0.89-1.05; p = 0.39), R0 resection, or reported survival outcomes. Findings were consistent in subgroup analyses of resectable or borderline resectable disease. The authors caution that the evidence may be subject to type 2 error and call for further randomised evidence.
Key findings
- Surgical resection rates were 68.9% with NACR and 71.5% with NAC (OR 0.96; 95% CI 0.89-1.05; p = 0.39).
- R0 resection rates were 70.7% with NACR and 64.2% with NAC (OR 1.04; 95% CI 0.90-1.20; p = 0.58).
- One-year survival was 71.3% vs. 72.4% (OR 0.99; 95% CI 0.81-1.20; p = 0.90), and three-year survival was 21.9% vs. 21.4% (OR 0.93; 95% CI 0.68-1.29; p = 0.68).
- Overall survival did not differ significantly between groups (HR 0.79; 95% CI 0.61-1.01; p = 0.06).
Why it matters
For patients with pancreatic ductal adenocarcinoma considered for neoadjuvant treatment, this synthesis of randomised evidence does not establish an advantage of adding radiotherapy to chemotherapy for resection or survival outcomes. The results help frame treatment comparisons while underscoring that apparent similarity is not proof of equivalence, particularly given the authors’ concern about possible type 2 error.
What to keep in mind
The authors state that the available evidence may be subject to type 2 error; further randomised evidence is needed.