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To the Editor: The CONKO-001 study of adjuvant gemcitabine for resected pancreatic cancer by Dr Oettle and colleagues¹ reported improved disease-free survival with the addition of chemotherapy compared with observation. The total rate of local recurrences in this study was approximately 40% in both groups, which appears low when compared with other published data. Local recurrence was a component of failure in 62% of all recurrences in the ESPAC-1 trial, which included 69 patients who also received no adjuvant therapy following surgery.²

Adjuvant fluorouracil-based chemoradiation therapy has shown improved local control and overall survival in other gastrointestinal malignancies³ and guidelines have recommended its use following surgery for pancreatic cancer.⁴ Previously, gemcitabine had not been used concurrently with radiation because of excessive toxicity.⁵ However, feasibility has been shown for using full-dose gemcitabine with concurrent radiation when smaller radiation fields are used (gross tumor volume with 1 cm margin) and elective nodal . . . [Full Text of this Article]

Anand T. Shivnani, MD
anand.shivnani@usoncology.com
Texas Cancer Center at Medical City Dallas
Dallas

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