Adjuvant CRT is associated with improved survival after pancreaticoduodenectomy. Adjuvant CRT was not associated with decreased survival in any risk group, even in propensity score and matched-pair analyses. Further studies evaluating adjuvant chemotherapy compared with adjuvant chemoradiation...
pubmed.ncbi.nlm.nih.gov
This is the retrospective study that pretty much let me know that you can never, ever, ever account for selection bias. Big ass data (the 2 biggest Whipple centers I believe), matched pair analysis and apparently overwhelming evidence of benefit to adjuvant chemorads (which has never been replicated in an actual clinical trial).
I don't have access to the whole brachy paper tonight, but I will read it. The pancreatic paper had some famously peculiar curves. (Curves that deviated within months of assignment of start time and almost certainly represented selection bias).
In the same way, that patients
selected to get ADT with brachy in an aggregate group made of of 75% UIR patient with a median f/u of less than 5 years shows no benefit compared to those
selected to not get ADT is well....nothing. Both selection bias and short f/u limit any meaningful conclusions IMO.
That Spratt is so angry is another matter.