title: Is concomitant radiotherapy necessary with gemcitabine-based chemotherapy in pancreatic cancer?
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: He-Jing
authors.initials: HJ
authors.lastname: Huang
authors.affiliation: Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Feng
authors.affiliation: Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: De-Jun
authors.initials: DJ
authors.lastname: Yang
authors.affiliation: Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Wang
authors.affiliation: Xin Zhang, De-Jun Yang, Chang-Ming Wang, Qing-Ping Cai, Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Qing-Ping
authors.initials: QP
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects; D016009:Chi-Square Distribution; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: Chemotherapy; Gemcitabine; Meta-analysis; Pancreatic cancer; Radiotherapy