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BACKGROUND: The effect of adjuvant treatment on survival in pancreatic cancer is unclear. We report the final results of the European Study Group for Pancreatic Cancer 1 Trial and update the interim results. METHODS: In a multicenter trial using a two-by-two factorial design, we randomly assigned 73 patients with resected pancreatic ductal adenocarcinoma to treatment with chemoradiotherapy alone (20 Gy over a two-week period plus fluorouracil), 75 patients to chemotherapy alone (fluorouracil), 72 patients to both chemoradiotherapy and chemotherapy, and 69 patients to observation. RESULTS: The analysis was based on 237 deaths among the 289 patients (82 percent) and a median follow-up of 47 months (interquartile range, 33 to 62). The estimated five-year survival rate was 10 percent among patients assigned to receive chemoradiotherapy and 20 percent among patients who did not receive chemoradiotherapy (P=0.05). The five-year survival rate was 21 percent among patients who received chemotherapy and 8 percent among patients who did not receive chemotherapy (P=0.009). The benefit of chemotherapy persisted after adjustment for major prognostic factors. CONCLUSIONS: Adjuvant chemotherapy has a significant survival benefit in patients with resected pancreatic cancer, whereas adjuvant chemoradiotherapy has a deleterious effect on survival.

Original publication

DOI

10.1056/NEJMoa032295

Type

Journal article

Journal

N Engl J Med

Publication Date

18/03/2004

Volume

350

Pages

1200 - 1210

Keywords

Aged, Antimetabolites, Antineoplastic, Chemotherapy, Adjuvant, Female, Fluorouracil, Humans, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local, Pancreatic Neoplasms, Prognosis, Proportional Hazards Models, Quality of Life, Radiotherapy Dosage, Radiotherapy, Adjuvant, Survival Analysis