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Recently, particle (proton and carbon-ion) therapy has emerged as a new radiotherapy modality. Given the unclear benefits of this approach, we summarized clinical outcomes of LAPC treated with concurrent chemoradiotherapy (CRT) using particle therapy to compare outcomes with current treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of particle therapy-based CRT in patients with LAPC and compare survival outcomes with photon CRT, combination CT, and single-agent CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Systematic review and single-arm meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>Studies evaluating LAPC treated with first-line particle CRT, photon CRT, combination CT, and single-agent CT were included. A single-arm meta-analysis was performed to calculate a pooled effect size using the DerSimonian and Laird random-effects model. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), response rate, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Across 42 studies and 3161 patients with LAPC, particle CRT achieved a pooled 1-year OS of 75.8% (95% confidence interval (CI) 71.3\u201379.7), 2-year OS of 41.3% (95% CI 35.6\u201347.3), and 1-year PFS of 51.7% (95% CI 43.2\u201360.0). Photon CRT achieved a 1-year OS of 59.4% and 2-year OS of 21.0%; combination chemotherapy 64.4% and 30.8%; and single-agent chemotherapy 37.2% and 13.1%. Pooled response rate after particle CRT was 48.8%. Grade \u2a7e3 upper gastrointestinal events (ulcer\/bleeding) were more frequent after particle CRT (4.3%) than after photon CRT (2.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Particle therapy CRT might have comparable survival outcomes in treating LAPC with combination CT, photon CRT, and single-agent CT. These findings support considering particle CRT as a valuable first-line treatment option for LAPC, which should be validated in randomized clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>The final search was conducted on December 31, 2024. The review protocol was registered in PROSPERO with the registration number CRD42023493665.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562848261465516","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:12:55Z","timestamp":1785582775000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Survival benefit of particle chemoradiotherapy in locally advanced unresectable pancreatic cancer: a systematic review and meta-analysis"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9084-855X","authenticated-orcid":false,"given":"Cheng-Shien","family":"Shieh","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, 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