Abstract 1476P
Background
There is a lack of robust level 1 evidence about the role of concurrent chemo-radiotherapy(CCRT) or radiotherapy(RT) after Neoadjuvant chemotherapy(NACT) in borderline resectable(BR) and Locally advanced(LA) pancreatic ductal adenocarcinoma(PDA). This systematic review aimed to explore whether CCRT or RT can produce any significant benefit to the outcomes of patients of BR and LA PDA patients; when added on the top of NACT.
Methods
We systematically searched PubMed, Medline, Embase, Cochrane database of systematic reviews; for articles published in the English language between 2005 and 2020. Eligible studies, which met our eligibility criteria, were screened by two authors independently. Studies were assessed for design and quality, and qualitative data synthesis was conducted to understand the impact of treatment on resection rate, R0 resection, pathological response, radiological response, progression-free survival, overall survival, local control, postoperative morbidity, and mortality.
Results
The search strategy resulted in 6635 published articles. After two rounds of screening 34 publications were included in the qualitative synthesis. We found three randomized control studies, one prospective cohort study, and the rest of the included studies are of retrospective nature. There is consistent evidence that the addition of CCRT or RT after NACT improves pathological complete response rate, pathological major response rate, pathological near-complete response, and local control. There are conflicting results in terms of other outcomes like resection rate, R0 resection, radiological response, progression-free survival, overall survival, treatment-related morbidity, or mortality.
Conclusions
CCRT or RT improves local control and pathological response in BR & LA, PDA; when added on the top of NACT. The role of modern radiotherapy in improving resectability, progression-free survival, overall survival, and reducing treatment morbidity and mortality requires further research.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.