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To the Editor The LAP07 trial found no significant difference in overall survival with chemoradiotherapy compared with chemotherapy alone for patients with locally advanced pancreatic cancer.1 Radiation therapy quality assessment was included in the study because this has been demonstrated to significantly affect outcomes in pancreatic cancer.2 The authors found that only 32% of patients received radiation per protocol with violations “mainly due to dose distribution heterogeneities.” In their results, they commented that “deviations from the planned schedule did not significantly influence overall survival,” but later in the discussion that “deviations from the planned protocol … did not affect significantly the overall survival.” Radiation quality assessment includes many other factors (target volume delineation, coverage limitations, etc) in addition to adherence to the radiation schedule. Was adherence to these factors studied for its influence on outcome? If not, we encourage the authors to report on those patients who were treated with radiation “per protocol” against those with anything “less than per protocol,” as was done in the study by Abrams and colleagues.2
Jani A, Horowitz DP. Radiation Therapy Deviations in Trial of Locally Advanced Prostate Cancer. JAMA. 2016;316(13):1409. doi:10.1001/jama.2016.9778