A Randomized Phase III Study of Adjuvant Gemcitabine Versus Gemcitabine Plus Concurrent Chemoradiation in Pancreatic Cancer Underwent Curative Intent (R0 / R1) Resection
Treatment plan and Randomization scheme:：
Patients will be randomized after stratification according to pathology report on section
margin, tumor size, lymph node metastasis:
Patients who are randomized to Arm 1 will receive adjuvant chemotherapy started within 4-8
weeks after the surgery, and administered at D1, D8 and D15 every 4 weeks for 6 cycles (6
months). Patients who are allocated to Arm 2 will receive sandwich treatment, which
comprised of the same adjuvant chemotherapy within 4-8 weeks after the surgery for 3 cycles
(3 months), followed by CCRT (start 4-6 weeks after the last dose of 3rd cycle chemotherapy)
and then another 3 cycles of gemcitabine monotherapy.
We anticipate the 2-year disease free survival will increase from 25% to 40% with the
incorporation of CCRT into the adjuvant treatment for post-operative pancreatic
adenocarcinoma. With a significant level of 0.05, 107 patients will be required for each
treatment arm to reach 80% statistical power. Since the drop out rate is approximately 10%,
265 patients will be enrolled to ensure that we will have 214 (107x2) eligible patients in
this study. We anticipate that we will recruit roughly 67 patients per year, therefore,
patient recruitment will be completed in 4 years.
Histo-/cyto-logically confirmed macroscopic complete resected pancreatic adenocarcinoma
1. The primary end-point is disease free survival.
2. The secondary end-points are overall survival; local and distant control rate, and the
quality of life.
3. The clinical and molecular prognostic factors for overall survival.
- Radiation fields encompass initial main tumor of pancreas only with a safe margin
of 1cm. Lymph node regions initially involved with tumor confirmed by excision
will be included in the clinical target volume. Elective radiation to uninvolved
lymph nodes will not be given.
Observational Model: Case Control, Time Perspective: Prospective
The primary end-point is recurrence-free survival.
Pancreatic Cancer Disease Committee
Tsann-Long Hwang, M.D.
Chang Gung Memorial Hospital
Taiwan: Department of Health