Top Line: Does adjuvant chemoradiation still have a role for resected pancreatic adenocarcinoma?
The Study: NRG/RTOG 0848 randomized 354 patients with resected pancreatic head adenocarcinoma who remained recurrence-free after 5 cycles of adjuvant gemcitabine-based chemotherapy to completion chemo alone versus an additional cycle followed by chemoradiation (81% via IMRT) 50.4 Gy in 28 fractions to the post-op bed and regional nodes with concurrent 5FU-based chemo. For the overall cohort, adding chemoradiation failed to improve disease-free or overall survival. However, a prespecified interaction analysis revealed a different story for node-negative patients (n=91) where adjuvant chemoradiation was associated with significant improvements in both disease-free (median 1.5 versus 2.3 years) and overall (median 3 versus 3.9 years) survival. As expected, modern radiation did not increase high-grade toxicity.
TBL: In an era increasingly focused on systemic intensification, more indolent node-negative disease may represent a subgroup where better local control can translate to better survival. | Abrams, J Clin Oncol 2026
The Study: NRG/RTOG 0848 randomized 354 patients with resected pancreatic head adenocarcinoma who remained recurrence-free after 5 cycles of adjuvant gemcitabine-based chemotherapy to completion chemo alone versus an additional cycle followed by chemoradiation (81% via IMRT) 50.4 Gy in 28 fractions to the post-op bed and regional nodes with concurrent 5FU-based chemo. For the overall cohort, adding chemoradiation failed to improve disease-free or overall survival. However, a prespecified interaction analysis revealed a different story for node-negative patients (n=91) where adjuvant chemoradiation was associated with significant improvements in both disease-free (median 1.5 versus 2.3 years) and overall (median 3 versus 3.9 years) survival. As expected, modern radiation did not increase high-grade toxicity.
TBL: In an era increasingly focused on systemic intensification, more indolent node-negative disease may represent a subgroup where better local control can translate to better survival. | Abrams, J Clin Oncol 2026