William F. Regine, MD

Surgical resection remains the sole modality that has proven capable of "curing" pancreatic cancer.

Despite attempted curative resection of localized adenocarcinoma of the pancreas, most patients experience a recurrence and die of their disease. The Gastrointestinal Tumor Study Group, European Organisation for Research and Treatment of Cancer, and European Study Group for Pancreatic Cancer trials have suggested the benefit of adjuvant therapy. However, the relatively few randomized trials available have not established a definite standard of care due to study limitations. Although these trials, and the recently published Charité Onkologie (CONKO)-001 trial, have shown a definite advantage of adjuvant chemotherapy, the most effective chemotherapy and the role of radiation therapy remain unclear. This review will discuss the data available from reported trials of adjuvant and neoadjuvant therapy in pancreatic cancer, address the issues leading to the ongoing controversies, and consider future directions for clinical trials.

The article by Mendenhall et al represents a comprehensive review of their own experience, as well as other large experiences in the literature, aimed at addressing the controversy of whether neck stage predicts local control after irradiation of head and neck cancer. The authors systematically explore this controversy in the setting of both definitive and postoperative therapy. Based on this review, and our own experience, we conclude that there are no significant data showing a correlation between neck stage and local control at the primary tumor site following irradiation of head and neck carcinoma.