Background:The optimal treatment strategy for locally advanced unresectable pancreatic cancer (LAPC) is still investigated. Therefore, we evaluated the role of radiotherapy (RT) in the management of LAPC in the modern era.Methods:A systematic review was conducted following the Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines. Eligible studies were about for LAPC treated with curative-intent modern RT techniques including intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and particle beam therapy (PBT) until September 2024.Results:In total, 53 observational studies, encompassing 2548 patients (993 treated with IMRT, 998 with SBRT, and 557 with PBT), met the inclusion criteria. Concurrent chemoradiotherapy (CCRT) was implemented in 28 studies, including only 3 studies in the SBRT group. Elective nodal irradiation (ENI) was adopted in 22%. The pooled 2-year overall survival (OS) rate was 29% (95% confidence interval [CI], 25–34%) for all patients, with no significant differences among RT techniques: 28% (95% CI, 22–34%) for IMRT, 26% (95% CI, 19–34%) for SBRT, and 43% (95% CI, 28–57%) for PBT (p= 0.1121). The pooled rate of acute hematologic toxicity (HT) ≥ grade 3 was 17% (95% CI, 9–26%), with significant differences among RT techniques: 23% (95% CI, 9–40%) for IMRT, 4% (95% CI, 0–11%) for SBRT, and 20% (95% CI, 6–37%) for PBT (p= 0.0181). In addition, CCRT (p= 0.0084) and ENI (p= 0.0145) significantly increased the risk of acute HT. Gastrointestinal toxicities rarely occurred.Conclusions:This systematic review and meta-analysis showed similar efficacy among modern RT techniques for LAPC management. Since almost all studies have single-arm design, and chemotherapy regimens have changed over time, conclusions must be drawn with caution. The use of modern RT techniques is individually selected according to clinical practice and resource availability.
背景：局部晚期不可切除胰腺癌（LAPC）的最佳治疗策略仍在探索中。为此，本研究评估了现代放疗技术在LAPC治疗中的作用。 方法：本研究遵循系统综述与荟萃分析报告规范进行系统性文献回顾。纳入标准为截至2024年9月、采用根治性现代放疗技术（包括调强放疗、立体定向体部放疗和粒子束治疗）治疗LAPC的相关研究。 结果：共纳入53项观察性研究，涵盖2548例患者（其中调强放疗993例，立体定向体部放疗998例，粒子束治疗557例）。28项研究采用同步放化疗方案，其中立体定向体部放疗组仅占3项。22%的研究采用了选择性淋巴结照射。全组患者汇总的2年总生存率为29%（95%置信区间25–34%），不同放疗技术间无显著差异：调强放疗组28%（22–34%）、立体定向体部放疗组26%（19–34%）、粒子束治疗组43%（28–57%）（p=0.1121）。≥3级急性血液学毒性汇总发生率为17%（9–26%），不同放疗技术间存在显著差异：调强放疗组23%（9–40%）、立体定向体部放疗组4%（0–11%）、粒子束治疗组20%（6–37%）（p=0.0181）。同步放化疗（p=0.0084）和选择性淋巴结照射（p=0.0145）显著增加急性血液学毒性风险。胃肠道毒性发生率较低。 结论：本系统综述与荟萃分析表明现代放疗技术在LAPC治疗中具有相似疗效。鉴于绝大多数研究为单臂设计，且化疗方案随时间不断演进，结论需谨慎解读。现代放疗技术的选择应依据临床实践和医疗资源进行个体化决策。
肿瘤(癌症)患者之家