Chemotherapy Versus Chemotherapy Followed by Concurrent Chemoradiotherapy for Unresectable Locally Advanced Pancreatic Cancer; A Retrospective Study

Background: Pancreatic cancer remains one of the deadliest cancers, often diagnosed during the advanced stage because of its vague symptoms. There’s still debate on whether adding concurrent chemoradiotherapy (CCRT) after chemotherapy offers additional benefit over chemotherapy alone. The aim of this study was to compare the outcomes of chemotherapy alone (CTA) versus chemotherapy followed by CCRT (CTA+CCRT) among patients with unresectable LAPC.Methods: This retrospective study was carried out on 66 patients who had unresectable LAPC treated between 2017 and 2022 at two oncology centers in Egypt. Patients were categorized into two groups: cases who received only gemcitabine-based chemotherapy (CTA group), and cases who received induction chemotherapy followed by radiotherapy with concurrent oral capecitabine (CTA+CCRT group). We evaluated treatment response, survival, resectability, and side effects.Results: The CTA+CCRT group had significantly better progression-free survival (11 vs. 4 months, p = 0.000) and overall survival (15 vs. 11 months, p = 0.000) compared to the CTA group. Complete response was significantly higher in the CTA+CCRT group (18.2% vs. 6.1%, p = 0.045), and lymph node involvement was significantly lower (33.3% vs. 63.6%, p = 0.014). Post-treatment CA 19.9 normalization was significantly associated with resectability in the CTA+CCRT group (p = 0.013). Toxicities were comparable between groups.Conclusion: Chemoradiotherapy demonstrates significant clinical benefit in managing of locally advanced pancreatic cancer as it improves local tumor control, decreases lymph node involvement, and enhances both overall survival in addition to the progression-free survival, along with increasing tumor resectability