Author Affiliations: Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom (Drs Neoptolemos and Cox) (email@example.com); and Department of Surgery, University of Heidelberg, Heidelberg, Germany (Dr Büchler).
In Reply: The ESPAC-3 periampullary cancer trial demonstrated a significant survival benefit for adjuvant chemotherapy, adjusting for prognostic variables. Dr Overman and colleagues have suggested a central pathology review to be more certain about the origin of the primary tumor in the patients enrolled in the trial. Such a review was not possible in a large trial spanning several continents because of logistical considerations and, for certain countries, regulatory constraints governing the international transport of clinical samples. To minimize error, the trial was restricted to pancreatic cancer centers and required completion of a detailed histopathology registration form as well as the pathology report itself being faxed to the central, international Clinical Trials Unit prior to any patient being considered against the eligibility criteria.
Neoptolemos JP, Cox TF, Büchler MW. Adjuvant Chemotherapy for Resected Periampullary Adenocarcinoma—Reply. JAMA. 2012;308(18):1855-1856. doi:10.1001/jama.2012.13955