Abstract
ObjectiveTo investigate the efficacy and safety of regional intra-arterial chemotherapy (RIAC) versus systemic chemotherapy for stage III/IV pancreatic cancer.MethodsRandomized controlled trials of patients with advanced pancreatic cancer treated by regional intra-arterial or systemic chemotherapy were identified using PubMed, ISI, EMBASE, Cochrane Library, Google, Chinese Scientific Journals Database (VIP), and China National Knowledge Infrastructure (CNKI) electronic databases, for all publications dated between 1960 and December 31, 2010. Data was independently extracted by two reviewers. Odds ratios and relative risks were pooled using either fixed- or random-effects models, depending on I2 statistic and Q test assessments of heterogeneity. Statistical analysis was performed using RevMan 5.0.ResultsSix randomized controlled trials comprised of 298 patients met the standards for inclusion in the meta-analysis, among 492 articles that were identified. Eight patients achieved complete remission (CR) with regional intra-arterial chemotherapy (RIAC), whereas no patients achieved CR with systemic chemotherapy. Compared with systemic chemotherapy, patients receiving RIAC had superior partial remissions (RR = 1.99, 95% CI: 1.50, 2.65; 58.06% with RIAC and 29.37% with systemic treatment), clinical benefits (RR = 2.34, 95% CI: 1.84, 2.97; 78.06% with RAIC and 29.37% with systemic treatment), total complication rates (RR = 0.72, 95% CI: 0.60, 0.87; 49.03% with RIAC and 71.33% with systemic treatment), and hematological side effects (RR = 0.76, 95% CI: 0.63, 0.91; 60.87% with RIAC and 85.71% with systemic treatment). The median survival time with RIAC (5–21 months) was longer than for systemic chemotherapy (2.7–14 months). Similarly, one year survival rates with RIAC (28.6%−41.2%) were higher than with systemic chemotherapy (0%−12.9%.).ConclusionRegional intra-arterial chemotherapy is more effective and has fewer complications than systemic chemotherapy for treating advanced pancreatic cancer.
Highlights
Pancreatic carcinoma is one of the deadliest cancers
The median survival time for patients with advanced pancreatic cancer is less than 6 months and the 1-year survival rate is less than 18% [3,4,5,6]
Quality Assessment One study explicitly stated that patients were selected using a random envelope process [17], whereas the other studies did not indicate that random selection was employed
Summary
Pancreatic carcinoma is one of the deadliest cancers. It is the only cancer with relative five-year survival rates that are less than 10%. This is due, in part, to the fact that 80% of patients have advanced unresectable disease at the time of diagnosis [1]. Gemcitabine (GEM), the most commonly used first-line drug in pancreatic cancer, only has a 5–15% response rate. The median survival time for patients with advanced pancreatic cancer is less than 6 months and the 1-year survival rate is less than 18% [3,4,5,6]
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