Neoadjuvant Chemoradiotherapy Versus Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-analysis of Randomised Controlled Trials
In brief
Neoadjuvant chemoradiotherapy shows no survival benefit over chemotherapy in pancreatic cancer
A meta-analysis of 24 randomized trials (2,273 patients) found that chemoradiotherapy and chemotherapy before surgery achieved similar surgical resection rates (about 70%), comparable R0 margins, and nearly identical 1-year survival (71% vs 72%). Overall survival did not differ, and the authors note the possibility of a type 2 error, urging further trials.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 3 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Shahin Hajibandeh, Shahab Hajibandeh, Jameel Alfarah, Alicja Psica, Syed Soulat Raza, David C Bartlett, et al.
- PMID
- 42545416
- DOI
- 10.1245/s10434-026-20319-7
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 9 August 2026): Neoadjuvant Chemoradiotherapy Versus Chemotherapy in PDAC
- Picked for Surgery (top studies of the week, 9 August 2026): Systematic review/meta‑analysis of NACR vs NAC RCTs in pancreatic cancer
Abstract
PURPOSE: This study was designed to evaluate the comparative outcomes of neoadjuvant chemoradiotherapy (NACR) and neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: Systematic search of electronic data sources was conducted, and all randomised controlled trials (RCTs) investigating outcomes of NACR and NAC in patients with PDAC were considered. Surgical resection rate, R0 resection, radiological response to treatment, and 1-5 years and overall survival were the evaluated outcome measures. RESULTS: Twenty-four RCTs reporting a total of 2273 patients who received NACR (n = 1152) and NAC (n = 1121) for PDAC were included. Both NACR and NAT were associated with comparable rate of partial response [11.8% (95% confidence interval [CI] 3.9-19.8) vs. 20.1% (95% CI 11.7-28.6)], stable disease [41.2% (95% CI 28-54.5%) vs. 47.1% (95% CI 30.3-63.8%)], or disease progression [17.3% (95% CI 4.1-30.5%) vs. 25.2% (95% CI 12.6-37.9%)] during treatment. The comparative meta-analyses demonstrated that there was no significant difference in surgical resection rate (68.9% vs. 71.5%, odds ratio [OR] 0.96; 95% CI 0.89-1.05, p = 0.39), R0 resection (70.7% vs. 64.2%, OR 1.04; 95% CI 0.90-1.20, p = 0.58), 1 year (71.3% vs. 72.4%, OR 0.99; 95% CI 0.81-1.20, p = 0.90), 3 years (21.9% vs. 21.4%, OR 0.93; 95% CI 0.68-1.29, p = 0.68), and overall survival (HR 0.79; 95% CI 0.61-1.01, p = 0.06) between NACR and NAC. Subgroup analyses on resectable or borderline resectable PDAC were consistent with the main analyses. CONCLUSIONS: The meta-analysis of best available evidence (level 1a) demonstrates that NACR and NAC are associated with comparable surgical resection rate, R0 resection, and survival in patients with PDAC. The available evidence may be subject to type 2 error and future randomised evidence is needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.