Journal of the National Cancer Institute Advance Access published online on November 25, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn428
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© Oxford University Press 2008.
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Adjuvant Chemoradiation for Pancreatic Cancer: Few Good Data, Much Debate
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Almost a quarter century after the publication of the first American clinical trial comparing chemoradiation with chemotherapy alone after surgery for pancreatic cancer, the debate over which treatment is better persists.
According to those involved, few issues in cancer care are more divisive. Reflecting entrenched positions, practices vary widely in the United States. Some centers don't offer chemoradiation; others throw everything they have against the cancer, including two different chemotherapies with chemoradiation between. There is also a continental divide: Most of the studies that suggested that chemoradiation doesn't work came from Europe, and more institutions there than in the United States use chemotherapy alone.
A self-described "fence sitter" put the issue this way: "The less we know about something, the more firm people's opinions are," said Jordan Berlin, M.D., clinical director of gastrointestinal oncology at Vanderbilt-Ingram Cancer Center in Nashville, Tenn. Berlin, who coauthored an editorial in the July 20
Entrenched Views
Europe versus the United States
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