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Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): a four-arm, multicentre, randomised, phase 2 trial.

Ghaneh P, Palmer D, Cicconi S, Jackson R, Halloran CM, Rawcliffe C et al, for the European Study Group for Pancreatic Cancer.

Lancet Gastro Hepatol 2023; 8: 157-168.

This study included 83 evaluable patients from 478 screened. Neoadjuvant treatment did not reduce the resection rate. Neoadjuvant treatment improved 1-year disease-free survival in both groups combined: 59 versus 39% for immediate surgery (hazard ratio 0.53, 95 per cent confidence interval 0.28 to 0.98, P=0.016.

Comment: The evidence for neoadjuvant chemotherapy is accumulating, but the number of suitable patients may be small.

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