Efficacy and safety of celiac plexus radiotherapy in Pancreatic cancer-related pain management: a systematic review and meta-analysis

Background: Advanced cancer pain, especially in pancreatic cancer, often requires interventional management. This meta-analysis evaluates the effectiveness and safety of celiac plexus radiotherapy in reducing pain, providing comprehensive insights for oncologic pain management. Methods: A systematic search was conducted on PubMed, Embase, and Cochrane databases through October 2024. The primary outcome was the BPI-SF (Brief Pain Inventory-Short Form) pain score reduction at 3 weeks. Data were analyzed using random-effects models, with heterogeneity assessed by I 2 statistics and publication bias evaluated via funnel plots, all conducted in R software 4.3.3. Results: This meta-analysis included 4 randomized controlled trials with 141 participants, median age 64.25 years. Most patients (91.75%) had pancreatic cancer. BPI-SF pain scores showed significant reductions at 3 weeks (RR −4.59, 95% CI: −7.77 to −1.42, P < 0.001, I 2 = 99%) and at 6 weeks (RR −2.35, 95% CI: −4.16 to −0.63, P < 0.01, I 2 = 98%). Morphine use showed no significant change at 3-week post-procedure. Celiac plexus radiosurgery demonstrated a favorable safety profile, with mild-to-moderate adverse events like fatigue (59.5%), abdominal pain (38%), and nausea (40.3%), and a few severe events (28% abdominal pain). Conclusion: Celiac plexus radiotherapy appears effective in reducing cancer-related pain at 3- and 6-week post-procedure with minimal impact on morphine use. It demonstrates a favorable safety profile, making it a promising option for managing advanced cancer pain.