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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., (Copyright 2004 Massachusetts Medical Society)

The article focuses on a study which compared the efficacy of fluorouracil and gemcitabine in terms of overall survival following pancreatic cancer resection. The study included 1,088 patients diagnosed with pancreatic ductal adenocarcinoma and underwent cancer resection at 159 pancreatic cancer centers in Europe, Australasia, Japan and Canada. The patients were randomized to receive either fluorouracil plus folinic acid or gemcitabine. Study authors found that gemcitabine is not superior to fluorouracil plus folinic acid in terms of overall survival in pancreatic cancer patients.

Several letters to the editor are presented in response to the article "Adjuvant Chemotherapy With Fluorouracil Plus Folinic Acid vs Gemcitabine Following Pancreatic Cancer Resection: A Randomized Controlled Trial," by J. P. Neoptolemos and colleagues, published in the 2001 issue.