Yue Chen, Department of Radiology, Renji Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 200001, China.
World J Gastroenterol. 2013 Nov 14;19(42):7461-71. doi: 10.3748/wjg.v19.i42.7461.
To compare the long-term clinical efficacy of chemotherapy plus radiotherapy (CRT) with that of radiotherapy alone (RT) or chemotherapy alone (CT) for locally advanced pancreatic carcinoma (LAPC).
Using manual and computer-aided methods, we searched the data through the databases, including PubMed/EmBase/CNKI/CQVIP/China Journals Full Text Database and websites and proceedings of major annual meetings such as ASCO and CSCO. The methodological quality of the included studies was assessed using the Jadad scoring system. Both English and Chinese publications were searched. We collected data from controlled clinical trials on CRT vs RT or CT for LAPC, and conducted a meta-analysis of 15 included studies. Meta-analysis was performed using RevMan4.2 Software according to the method recommended by Cochrane Collaboration.
Fifteen eligible randomized controlled trials including a total of 1128 patients were screened. Jadad score was 2 in only one article, and 3-4 in the remaining 14 studies. The meta-analysis showed that CRT was superior in the 6- and 12-mo survivals to the RT alone group or CT alone group (P = 0.0001 and P = 0.02, respectively), whereas the 18-mo survival showed no significant difference (P = 0.23). Subgroup analysis showed that the 6-, 12-, and 18-mo survivals were not significantly different between the CRT group and CT group (P = 0.07, P = 0.23, and P = 0.91, respectively). Notably, the CRT group had significantly better 6-, 12-, and 18-mo survivals than the RT group (all P < 0.01). CRT group had significantly more grade 3-4 treatment-related hematologic and non-hematologic toxicities than the CT group or RT group (all P < 0.01).
Compared with CT or RT, CRT can benefit the long-term survival of LAPC patients, although it may also increase treatment-related toxicities.
比较化疗联合放疗（CRT）与单纯放疗（RT）或单纯化疗（CT）治疗局部晚期胰腺癌（LAPC）的长期临床疗效。
采用手工和计算机辅助方法，通过包括 PubMed/EmBase/CNKI/CQVIP/中国期刊全文数据库和主要年度会议网站（如 ASCO 和 CSCO）在内的数据库进行数据检索。使用 Jadad 评分系统评估纳入研究的方法学质量。检索 CRT 与 RT 或 CT 治疗 LAPC 的对照临床试验的英文和中文文献，并对 15 项纳入研究进行荟萃分析。使用 RevMan4.2 软件按照 Cochrane 协作组推荐的方法进行荟萃分析。
筛选出 15 项符合条件的随机对照试验，共纳入 1128 例患者。仅有 1 篇文章的 Jadad 评分为 2 分，其余 14 篇均为 3-4 分。荟萃分析显示，与 RT 组或 CT 组相比，CRT 在 6 个月和 12 个月的生存率方面具有优势（P = 0.0001 和 P = 0.02），而 18 个月的生存率无显著差异（P = 0.23）。亚组分析显示，CRT 组与 CT 组在 6 个月、12 个月和 18 个月的生存率方面无显著差异（P = 0.07、P = 0.23 和 P = 0.91）。值得注意的是，CRT 组 6 个月、12 个月和 18 个月的生存率明显优于 RT 组（均 P < 0.01）。CRT 组的 3-4 级治疗相关血液学和非血液学毒性明显多于 CT 组和 RT 组（均 P < 0.01）。
与 CT 或 RT 相比，CRT 可使 LAPC 患者获得长期生存获益，但也可能增加治疗相关毒性。
