Pain response after palliative-intent radiotherapy for pancreatic cancer: a systematic review.

BACKGROUND: To date, no review has specifically focused on palliative-intent radiotherapy (RT) for pancreatic cancer (PC)-related pain. This study aimed to evaluate the pain response after palliative-intent RT for PC-related pain. METHODS: A comprehensive literature search was conducted using PubMed, Ichushi-Web, and the Cochrane Library for studies published between 1971 and 2024. Studies in which palliative-intent RT was administered for PC-related pain were included. Extracted Data were independently assessed by three reviewers. RESULTS: Of the 629 studies identified through the database search, 11 met the inclusion criteria. The most frequently used palliative-intent RT schedules were 30 Gy in 10 fractions for conventional RT and 25 Gy in a single fraction for stereotactic body radiotherapy (SBRT). In addition, 8 Gy once weekly (24 Gy in 3 fractions) RT has also been reported. Because the methods used for pain assessment varied across the included studies, a meta-analysis was considered inappropriate. Pain associated with PC improved following palliative-intent conventional RT (pain response rate, 69-94%), palliative-intent SBRT (pain response rate, 53-90%), and 8 Gy once weekly RT (pain response rate, 80%). A few grade ≥ 3 gastrointestinal adverse events were reported (< 10%). CONCLUSION: Palliative-intent RT appears to be a promising approach for alleviating PC-related pain. However, the current evidence is heterogeneous in terms of target selection and dose-fractionations. Further studies, including randomized controlled trials, may help identify optimal treatment strategies.