title: A Meta-analysis of Randomized Clinical Trials of Chemoradiation Therapy in Locally Advanced Pancreatic Cancer.
abstract: OBJECTIVE
  Pancreatic cancer is the fourth most common cause of cancer deaths in the USA. Despite the fact that the radiotherapy in addition to chemotherapy (CT) is frequently employed, the role of chemoradiation therapy (CRT) in the treatment of locally advanced pancreatic cancer (LAPC) remains controversial. We conducted a systemic review and meta-analysis to evaluate the effect of radiation treatment in addition to CT in patients with LAPC.
  
  
  METHODS
  Only randomized controlled trials that compared CRT to CT and reported time to event summary were included in this study. The primary end point was overall survival expressed as hazard ratio (HR). Due to significant heterogeneity, random-effects model statistics were used.
  
  
  RESULTS
  Five eligible studies were included with a total of 593 patients (CT, N = 298; CRT, N = 295). Two studies demonstrated statistically significant difference in OS in favor of CRT and the rest of the studies did not demonstrate any significant differences. Meta-analysis demonstrated that there was a non-significant trend toward a survival benefit in the CRT arm; HR 0.913 (95 % CI 0.595-1.400, p = 0.675). No significant differences in overall results were seen with sensitivity analysis.
  
  
  CONCLUSIONS
  The addition of radiation therapy to CT in the treatment of LAPC is associated with a non-significant trend toward survival advantage. Larger randomized controlled trials using modern CT regimens and radiation techniques are needed to further clarify the role of radiation in this setting.
authors.affiliation: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive FOB-2, Tampa, FL, 33612, USA.
authors.forename: Chenwi
authors.initials: C
authors.lastname: Ambe
authors.forename: William
authors.initials: W
authors.lastname: Fulp
authors.forename: Gregory
authors.initials: G
authors.lastname: Springett
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffe
authors.forename: Amit
authors.initials: A
authors.lastname: Mahipal
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*