{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:34:37Z","timestamp":1792373677323,"version":"4.4.0"},"reference-count":25,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"24","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2026,8,20]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>To assess whether adding fluoropyrimidine sensitized radiotherapy (CXRT) to adjuvant chemotherapy improves overall survival (OS) after curative intent resection of the pancreatic head.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This was a multicenter, randomized phase III, two step trial. Step 1: gemcitabine versus gemcitabine + erlotinib (previously reported). Step 2: random assignment to sixth chemotherapy cycle \u00b1 CXRT after five cycles of step 1 chemotherapy without progression. Outcomes of step 2 random assignment are reported here. Assuming 17 months median OS (chemotherapy alone), the sample size was 354 patients (hazard ratio [HR], 0.76, 80% power, one-sided \u03b1 = .05, 316 OS events). OS\/disease-free survival (DFS) were estimated by Kaplan-Meier and arms compared using the log-rank test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 354 patients (median age 63, 55% male, 56% performance status, 1) were randomly assigned to chemotherapy (174) or chemotherapy + CXRT (180). Univariable median and 5-year OS (90% CIs) were 2.6 years (2.1-3.1) and 23.1% (17.7-28.6) for chemotherapy alone, and 2.3 years (2.0-2.6) and 27.9% (22.2-33.6) for chemotherapy + CXRT. The OS primary end point was not met (HR, 0.96 [90% CI, 0.79 to 1.18]; one-sided\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .38, two-sided\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .77). Chemotherapy + CXRT was associated with a trend for improved DFS (univariably; HR, 0.82 [95% CI, 0.65 to 1.03];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .089), without increase in grade 4\/5 toxicities. However, grade 3 toxicity increased (38%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      19%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Significantly, treatment by nodal status interactions showed that CXRT improved OS (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0063) and DFS (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .014) in node-negative patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Overall, the addition of adjuvant CXRT to adjuvant gemcitabine did not statistically significantly improve OS, DFS, or increase grade 4\/5 toxicity. For node-negative patients, CXRT improved OS and DFS. These results, if confirmed in studies with current or future systemic therapies, would support the use of adjuvant\/neoadjuvant CXRT for node-negative patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco-25-02520","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T20:00:08Z","timestamp":1781035208000},"page":"2316-2328","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":4,"title":["Adjuvant Chemotherapy \u00b1 Chemoradiotherapy for Adenocarcinoma of the Pancreatic Head: Results of the Radiotherapy Random Assignment of NRG Oncology\/RTOG 0848"],"prefix":"10.1200","volume":"44","clinical-trial-number":[{"clinical-trial-number":"nct01013649","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5609-4136","authenticated-orcid":false,"given":"Ross A.","family":"Abrams","sequence":"first","affiliation":[{"name":"Radiation Oncology, Retired-Rush University Medical Center, Professor Emeritus, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Statistics, NRG Oncology Statistics and Data Management Center, Philadelphia, PA"},{"name":"Department of Statistics, American College of Radiology, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-6355","authenticated-orcid":false,"given":"Karyn A.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Regine","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Maryland School of Medicine and Greenebaum Cancer, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6221-7147","authenticated-orcid":false,"given":"Howard P.","family":"Safran","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Rhode Island Hospital, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1906-2186","authenticated-orcid":false,"given":"Chandan S.","family":"Guha","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8239-9147","authenticated-orcid":false,"given":"Lisa A.","family":"Kachnic","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Gillin","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics, University of Texas, M D Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6513-3491","authenticated-orcid":false,"given":"Philip A.","family":"Philip","sequence":"additional","affiliation":[{"name":"Department of Oncology and Pharmacology, Wayne State University School of Medicine, Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7106-0735","authenticated-orcid":false,"given":"Andrew M.","family":"Lowy","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Moores Cancer Center, UC San Diego, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8076-9199","authenticated-orcid":false,"given":"Eileen","family":"O'Reilly","sequence":"additional","affiliation":[{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Luc","family":"Van Laethem","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4459-4923","authenticated-orcid":false,"given":"Samantha A.","family":"Seaward","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kaiser Permanente Oncology Clinical Trials, Vallejo, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2597-7091","authenticated-orcid":false,"given":"Abraham J.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1714-0021","authenticated-orcid":false,"given":"Jennifer J.","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Hematology and Medical Oncology, Perlmutter Cancer Center of NYU Langone Health, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raid M.","family":"Aljumaily","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, Internal Medicine, University of Oklahoma, Oklahoma City, OK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"DiPetrillo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Brown University Health, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5380-4948","authenticated-orcid":false,"given":"Ravit","family":"Geva","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pramila Rani","family":"Anne","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1480-7887","authenticated-orcid":false,"given":"Darla K.","family":"Liles","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hematology Oncology, East Carolina University, Greenville, 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