TOPLINE

In patients with unresectable locally advanced pancreatic cancer (LAPC), particle chemoradiotherapy (CRT) achieved a pooled 1-year overall survival (OS) of more than 75% and 2-year OS of more than 40% — comparably higher than rates observed with photon CRT, combination chemotherapy (CT), and single-agent CT.

METHODOLOGY

• A systematic review and single-arm meta-analysis included 42 studies including patients with LAPC who underwent first-line particle CRT, photon CRT, combination CT, or single-agent CT, published from 2011 onward.
• Researchers analyzed pooled 1- and 2-year OS and progression-free survival (PFS), treatment response rates, and grade ≥ 3 adverse events.
• A total of 820 patients received particle CRT (264 proton, 556 carbon-ion), 1730 received photon CRT, 316 received combination CT, and 295 received single-agent CT.
• Particle CRT and photon CRT regimens typically used gemcitabine as a concurrent regimen followed by S-1 (tegafur-gimeracil-oteracil). In the combination CT group, FOLFIRINOX or nab-paclitaxel–gemcitabine regimen was used, and in the single-agent CT group, gemcitabine was used uniformly.

TAKEAWAY

• Particle CRT achieved a pooled 1-year OS of 75.8% (95% CI, 71.3-79.7) and 2-year OS of 41.3% (95% CI, 35.6-47.3), followed by combination CT (64.4% and 30.8%), photon CRT (59.4% and 21.0%), and single-agent CT (37.2% and 13.1%).
• Pooled 1-year PFS was 51.7% (95% CI, 43.2-60.0) for particle CRT, 44.8% for combination CT, 36.6% for photon CRT, and 17.2% for single-agent CT.
• Pooled treatment response rate (at least partial response) was 48.8% for particle CRT, 26.4% for photon CRT, 37.7% for combination CT, and 18.3% for single-agent CT.
• Grade ≥ 3 upper gastrointestinal ulcer or bleeding occurred in 4.3% of the particle CRT group vs 2.1% of the photon CRT group; grade ≥ 3 leukopenia was observed in 27.9% of the particle CRT group, 23.8% of the combination CT group, 18.9% of the photon CRT group, and 6.5% of the single-agent CT group.

IN PRACTICE

"Particle CRT shows potential as an option of first-line treatment for unresectable LAPC," the authors of the study wrote.

SOURCE

The study was led by Cheng-Shien Shieh and Po-Long Cheng, Taipei Medical University Hospital, Taipei, Taiwan. It was published online on August 1 in Therapeutic Advances in Gastroenterology.

LIMITATIONS

This was a single-arm meta-analysis with data primarily from retrospective analysis. The analysis did not include studies evaluating targeted therapy or immunotherapy, which are evolving treatment options.

DISCLOSURES

The study was supported by a grant from Taipei Medical University. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.