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Importance: The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear. Objective: To define patterns of recurrence after adjuvant chemotherapy and the association with survival. Design, Setting, and Participants: Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019. Interventions: Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine. Main Outcomes and Measures: Overall survival, recurrence, and sites of recurrence. Results: Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98; P=.03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45; P=.04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09; P=.27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32

We report on a Fortran module for the generation of turbulent inflow and initial data for use in fluid simulation codes. We explain the uses and limitations of the module and how to incorporate it into an existing code. The data created by the module is examined, and the code is tested for parallel performance on shared memory, multi-processor computers; a complete listing is included., The original document contains color images.

Continuing work in the design of shock ignition targets is described. Because of reduced implosion velocity requirements, low target adiabats, and efficient drive by short wavelength lasers, these targets produce high gain (>100) at laser energies well below 1 megajoule. Effects of hydrodynamic instabilities like Rayleigh-Taylor or Richtmyer- Meshkov are greatly reduced in these low-aspect ratio targets. Of particular interest is the optimum ratio of ignitor to compression pulse energy. A simple pellet model and simulation-derived coupling coefficients are used to analyze optimal fuel assembly, and determine that shock ignition allows enough control to create theoretically optimum assemblies. The effects on target design due to constraints on the compression and ignitor pulse intensities are also considered and addressed. Significant sensitivity is observed from low-mode perturbations because of large convergence ratios, but a more powerful ignitor can mitigate this., Published in Physics of Plasmas, v17 p042701, 2010. Prepared in cooperation with Berkeley Research Associates, Beltsville, MD. The original document contains color images.

In this paper, we report on recent numerical simulations of inertial-confinement-fusion (ICF) implosions using the FAST radiation hydro-code at the U.S. Naval Research Laboratory. Our study focuses on three classes of shock-ignited target designs utilizing less than 1 MJ of direct KrF laser energy, which was "zoomed" to maximize the coupling efficiency. In the shock-ignition approach, a moderate-intensity, compressive laser pulse is followed by a short-duration high-intensity spike that launches a spherically-convergent shock wave to ignite a thick shell of compressed fuel. Such an arrangement appears to offer several significant advantages, including a low ignition threshold, high gain, and less susceptibility to the deleterious effects of hydrodynamic and laser-plasma instabilities. According to one-dimensional simulations, fusion gains over 200 can be achieved with shock-ignited targets using less than 750 kJ of laser energy. This represents a significant improvement in performance over conventional centrally-ignited designs. To examine the stability of these targets, several two-dimensional simulations were also performed that incorporated realistic perturbation sources such as laser imprinting and roughness spectra for inner/outer pellet surfaces. Although the simulations indicate that appreciable low-mode distortion of the fuel shell can occur at late time as a result of these perturbations, high gains are still achieved in many cases owing to the low in-flight aspect ratios of shock-ignited targets. We should remark, though, that the high convergence ratios of these same designs suggest that other sources of low-mode asymmetries, which were not considered in this study (e.g., beam misalignment and energy-balance errors), may be important in determining overall pellet stability and performance., Presented at the International Conference on High Energy Density Physics (2nd) held in Austin, TX in May 2009. Published in High Energy Density Physics, 2010. The original document contains color images.