Adjuvant Chemotherapy ± Chemoradiotherapy for Adenocarcinoma of the Pancreatic Head: Results of the Radiotherapy Random Assignment of NRG Oncology/RTOG 0848

Adding chemoradiotherapy to adjuvant chemotherapy after curative-intent resection of pancreatic head adenocarcinoma did NOT improve overall survival — the primary endpoint of the phase 3 NRG Oncology/RTOG 0848 trial (n=354) was not met (HR 0.96; 90% CI 0.79-1.18; two-sided P=.77). Median overall survival was 2.6 years with chemotherapy alone versus 2.3 years with added chemoradiotherapy, and 5-year survival was 23.1% versus 27.9%. Chemoradiotherapy did not increase grade 4-5 toxicity but doubled grade 3 toxicity (38% vs 19%; P<.001). An interaction analysis suggested benefit in overall and disease-free survival among node-negative patients (P=.0063 and P=.014); the authors treat this as a hypothesis requiring confirmation rather than a definitive result.