Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2014; 20(46): 17648-17655
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17648
Is concomitant radiotherapy necessary with gemcitabine-based chemotherapy in pancreatic cancer?
Xin Zhang, He-Jing Huang, Dan Feng, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai
Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
He-Jing Huang, Department of Hematology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Dan Feng, Department of Oncology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
Author contributions: Zhang X, Huang HJ and Feng D contributed equally to this work; all authors contributed to the manuscript.
Supported by National Natural Science Foundation of China, No. 81402359 and No. 81372670
Correspondence to: Qing-Ping Cai, Professor, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Huangpu District, Shanghai 200003, China. caiqp1969@hotmail.com
Telephone: +86-21-81885601 Fax: +86-21-81885601
Received: March 25, 2014
Revised: June 5, 2014
Accepted: July 29, 2014
Published online: December 14, 2014
Abstract

AIM: To evaluate the efficacy and safety of gemcitabine (GEM) plus radiotherapy compared with GEM alone for pancreatic cancer (PC).

METHODS: A systematic search for eligible studies comparing gemcitabine plus radiotherapy with gemcitabine alone for PC was performed using MEDLINE, EMBASE, and the Cochrane Library. A quality assessment was performed in each study. Meta-analyses were performed to study the pooled effects of relative risk with 95% confidence interval (CI).

RESULTS: A total of 336 participants from four original studies were included. Gemcitabine plus radiotherapy resulted in comparable overall survival (HR = 0.84, 95%CI: 0.53-1.34, P = 0.48) and progress free survival (HR = 0.99, 95%CI: 0.97-1.01, P = 0.36) to gemcitabine alone. Moreover, concomitant radiotherapy was associated with a significantly higher incidence of severe (grade 3 or greater) toxicities, mainly anemia, leukocytopenia, thrombocytopenia, anorexia, nausea/vomiting, and asthenia/fatigue.

CONCLUSION: Radiotherapy is not beneficial with gemcitabine-based chemotherapy for PC. Further exploration for better radiotherapy approaches and therapeutic regimens for the treatment of PC is warranted.

Keywords: Pancreatic cancer, Radiotherapy, Chemotherapy, Gemcitabine, Meta-analysis

Core tip: We performed this meta-analysis to evaluate the efficacy and safety of gemcitabine plus radiotherapy compared with gemcitabine alone for pancreatic cancer (PC). A total of 336 participants from four original studies were included. Gemcitabine plus radiotherapy resulted in comparable survival results to gemcitabine alone. Moreover, concomitant radiotherapy was associated with a significantly higher incidence of severe (grade 3 or greater) toxicities, mainly anemia, leukocytopenia, thrombocytopenia, anorexia, nausea/vomiting, and asthenia/fatigue. Therefore, radiotherapy is not beneficial with gemcitabine-based chemotherapy for PC. Further exploration for better radiotherapy approaches and therapeutic regimens in the treatment of PC is still warranted.