Impact of Different Modalities of Radiotherapy in Locally Advanced Pancreatic Cancer: A Review and Meta-Analysis

Pancreatic ductal adenocarcinoma (PDAC) remains a high-mortality cancer in dire need of more effective therapeutic strategies. Six randomized controlled trials have compared chemotherapy with chemoradiotherapy in patients with locally advanced pancreatic cancer (LAPC), but these trials only involved conventional external beam radiotherapy. Over the last decade, stereotactic body radiation therapy (SBRT) has risen to prominence over conventional external beam radiotherapy. Moreover, endoscopic ultrasound (EUS)-guided brachytherapy has been used in a trial setting, though it is not routinely used in LAPC. In this review, we report a meta-analysis of randomized controlled trials that have compared chemotherapy with chemoradiotherapy and review two-arm trials assessing survival outcomes with chemotherapy and SBRT over chemotherapy only. We also review the increasing role of EUS-guided brachytherapy.