How do you justify adjuvant radiotherapy in pancreatic cancer?

Even though it was flawed in every imaginal way, ESPAC1 had a high impact and made post-op chemoradiation experimental. Prior to that, radiation was not based on very much evidence. GITSG was a 40-patient positive study; the EORTC trial was negative. After the ESPAC1, the focus shifted to neoadjuvant chemoradiation for borderline resectable disease which was defined as any vein or artery involvement <180 degrees in 2007. There is good evidence that chemoradiation improves margin negative resecti...

In terms of randomized data, the only positive trial is GITSG. This is so small, accrued over such a long time, and was done such a long time ago, that it cannot be considered compelling evidence for treatment. The EORTC trial had similar results to GITSG, but the results did not reach statistical significance. Many have argued that this trial was underpowered, but it cannot be called a positive trial. Institutional non-randomized reports from Mayo and Hopkins, and population studies based on SE...