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The 2004 European trial that showed chemotherapy after pancreatic cancer surgery doubled five-year survival, while adding radiotherapy to the chemotherapy made survival worse, a result that split European and American practice for a decade.
ESPAC-1 used a two-by-two factorial design to randomise 289 patients with resected pancreatic ductal adenocarcinoma: 73 to chemoradiotherapy alone (20 Gy over two weeks plus fluorouracil), 75 to chemotherapy alone (fluorouracil), 72 to both and 69 to observation. With 237 deaths and a median follow-up of 47 months, the estimated five-year survival was 10 percent among patients assigned chemoradiotherapy and 20 percent among those who did not receive it (P = 0.05), and 21 percent among those who received chemotherapy against 8 percent among those who did not (P = 0.009); the chemotherapy benefit persisted after adjustment for prognostic factors. The authors concluded that adjuvant chemotherapy has a significant survival benefit whereas adjuvant chemoradiotherapy has a deleterious effect.
The origin of the European position that adjuvant treatment means chemotherapy alone; CONKO-001, ESPAC-3, ESPAC-4 and PRODIGE 24 all built on it, and the role of radiotherapy remains contested (LAP07, PREOPANC).
Shares Neoadjuvant / adjuvant / perioperative, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, New England Journal of Medicine, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy and the tag pancreatic-evidence.
Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy and the tag pancreatic-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy and the tag pancreatic-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Resectable pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy and the tag pancreatic-evidence.