ESPAC-1

ESPAC-1 randomised 289 patients with resected pancreatic ductal adenocarcinoma in a two-by-two factorial design; the final analysis (median follow-up 47 months, 237 deaths) gave an estimated five-year survival of 21 percent among patients who received chemotherapy against 8 percent among those who did not (p 0.009), and 10 percent among those who received chemoradiotherapy against 20 percent among those who did not (p 0.05), the chemotherapy benefit persisting after adjustment for prognostic factors. The authors concluded that adjuvant chemotherapy has a significant survival benefit whereas adjuvant chemoradiotherapy is deleterious, a conclusion that separated European practice (chemotherapy alone: ESPAC-3, ESPAC-4, PRODIGE 24) from the North American use of adjuvant chemoradiotherapy for a decade and that the negative LAP07 and CONKO-007 results later echoed in the locally advanced setting. Its split-course 20 Gy radiotherapy and lack of quality assurance were criticised at the time, but no later randomised trial has shown adjuvant chemoradiotherapy improves survival.