Is concomitant radiotherapy necessary with gemcitabinebased chemotherapy in pancreatic cancer?

AIM: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 freesurvival(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.CONCLUSION: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.