What is the role of adjuvant radiation in R0 node positive resected pancreatic adenocarcinoma in light of the recently presented RTOG 0848 abstract?

There are three options here in my practice. 1) Treat, 2) don't treat, and 3) "watch and wait, then ablate" (for a local recurrence).

In general, I treat patients with CXRT who have positive margins (IMRT 45 Gy/25# to regional volume with SIB of 62.5 Gy to the margin. If it is an R2 resection (which...

There is no role/evidence of a survival benefit in RTOG 0848 or any other randomized trial for patients with R0 / N+. It is an open question whether local control would be important enough to improve survival in the context of adjuvant FOLFIRINOX.

In light of the recent RTOG 0848 results, there is a case to be made for offering adjuvant CRT, particularly with node-negative disease.

I’m a bit unclear after reading the abstract and think it might be helpful to see the final manuscript. Do patients with node negative disease do better because the node positive patients die from metastatic disease? Are all node negative patients the same? Would also like to see the chemotherapy re...