Systematic review and pooled analysis of single-arm studies of carbon ion radiotherapy for locally advanced pancreatic cancer

There is no high-level evidence for the role of carbon ion radiotherapy (CIRT) in treating locally advanced pancreatic cancer (LAPC). Pooled analysis of single-arm studies evaluated CIRT with or without chemotherapy for LAPC. The analysis included nine studies with a total of 406 LAPC patients. The pooled local control rates at 1 and 2 years were 84% and 64%, respectively, with higher prescribed doses showing improved local control compared with lower doses. The overall survival rates at 1 and 2 years were 65% and 38%, respectively. A clear survival benefit with CIRT was seen in studies with concurrent chemotherapy compared without concurrent chemotherapy (73% versus 53% at 1 year; 44% versus 22% at 2 years). Chemotherapy prior to CIRT reduced the incidence of distant metastases (69% versus 85%). The pooled incidences of grade ≥ 4 nonhematologic and hematologic toxicities were 8% and 24%, respectively. The authors conclude that CIRT was associated with encouraging local control and survival outcomes among LAPC patients.