Middle East Journal of Cancer

The Effect of Neoadjuvant Chemoradiotherapy in Converting Unresectable and Locally Advanced Pancreatic Adenocarcinoma to Resectable Status: A Systematic Review and Meta-analysis

Document Type : Review Article(s)

Authors

Bahareh Shateri Amiri 1
Sahar Mansouri 2
Nika Farsinejad 2
Vahid Rahmanian 3
Mehdi Khosravi Mashizi 4
Samira Soleimanpour 5

1 Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, I

2 School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran

4 Department of General Surgery, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran

5 Department of Medical Library and Information Sciences, Educational Development Center, Iran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30476/mejc.2026.106444.2266
Abstract
Background: Neoadjuvant chemoradiotherapy (NCRT) is increasingly used in locally advanced unresectable pancreatic adenocarcinoma. In the present study, we systematically evaluated the effects of NCRT on downstaging, resectability, and survival.
Method: A systematic review and meta-analysis of 70 full-text studies published before December 2023 (PubMed, Scopus, and Web of Science) was conducted. Data were extracted independently. Random-effects models were applied with substantial heterogeneity (Cochran’s Q, I²). Subgroup analyses and publication-bias assessments (Egger’s test, funnel plots, trim-and-fill) were conducted (P < 0.05).
Results: The pooled conversion rate from unresectable to resectable disease was 30.6% (95% confidence interval (CI): 28.2%–32.2%). Conversion was higher with chemoradiotherapy than with chemotherapy alone (32.5% vs. 22.9%). Tumors in the pancreatic body showed a higher conversion rate than tumors in mixed locations (37.0% vs 29.7%). Overall tumor size reduction was 23% (95% CI: 15%–30%), greater with chemoradiotherapy than chemotherapy (25% vs. 16.7%). Mean overall survival after neoadjuvant therapy was 17.96 months (95% CI: 16.40–19.52), with no clear difference between regimens. Disease-free survival was 12.97 months (95% CI: 11.22–14.72). The pooled R0 resection rate was 41.7% (95% CI: 33.2%–50.2%).
Conclusion: The results of the study indicate that NCRT improves conversion to resection and tumor shrinkage versus chemotherapy alone, particularly for pancreatic body tumors, but does not demonstrate a consistent survival advantage.

Highlights

Bahareh Shateri Amiri (google scholar)

Vahid Rahmanian (google scholar)

 

Keywords

Pancreatic neoplasms
Neoadjuvant therapy
Treatment outcome
Tumor size reduction
Subjects

How to cite this article:

Shateri Amiri B, Mansouri S, Farsinejad N, Rahmanian V, Khosravi Mashizi M, Soleimanpour S. The effect of neoadjuvant chemoradiotherapy in converting unresectable and locally advanced pancreatic adenocarcinoma to resectable status: A systematic review and meta-analysis. Middle East J Cancer. 2026; 17(3): 177-96. doi: 10.30476 /mejc.2026. 106444.2266.

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