@prefix rdf: . @prefix ns1: . rdf:type ns1:RelevantPaper , ns1:ReferencePaper , ns1:CitationPaper . @prefix rdfs: . rdfs:seeAlso , , , . @prefix bibo: . bibo:cites , , , , , , , , , , , , , , , , , , ; ns1:cocitationWith , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ; ns1:hasRelevantBibliographicResourceOf _:b349965520 , _:b349965521 , _:b349965522 , _:b349965523 , _:b349965524 , _:b349965525 , _:b349965526 , _:b349965527 , _:b349965528 , _:b349965529 , _:b349965530 , _:b349965531 , _:b349965504 , _:b349965505 , _:b349965506 , _:b349965507 , _:b349965508 , _:b349965509 , _:b349965510 , _:b349965511 , _:b349965512 , _:b349965513 , _:b349965514 , _:b349965515 , _:b349965516 , _:b349965517 , _:b349965518 , _:b349965519 , _:b349965488 , _:b349965489 , _:b349965490 , _:b349965491 , _:b349965492 , _:b349965493 , _:b349965494 , _:b349965495 , _:b349965496 , _:b349965497 , _:b349965498 , _:b349965499 , _:b349965500 , _:b349965501 , _:b349965502 , _:b349965503 , _:b349965472 , _:b349965473 , _:b349965474 , _:b349965475 , _:b349965476 , _:b349965477 , _:b349965478 , _:b349965479 , _:b349965480 , _:b349965481 , _:b349965482 , _:b349965483 , _:b349965484 , _:b349965485 , _:b349965486 , _:b349965487 , _:b349965456 , _:b349965457 , _:b349965458 , _:b349965459 , _:b349965460 , _:b349965461 , _:b349965462 , _:b349965463 , _:b349965464 , _:b349965465 , _:b349965466 , _:b349965467 , _:b349965468 , _:b349965469 , _:b349965470 , _:b349965471 , _:b349965440 , _:b349965441 , _:b349965442 , _:b349965443 , _:b349965444 , _:b349965445 , _:b349965446 , _:b349965447 , _:b349965448 , _:b349965449 , _:b349965450 , _:b349965451 , _:b349965452 , _:b349965453 , _:b349965454 , _:b349965455 , _:b349965424 , _:b349965425 , _:b349965426 , _:b349965427 , _:b349965428 , _:b349965429 , _:b349965430 , _:b349965431 , _:b349965432 , _:b349965433 , _:b349965434 , _:b349965435 , _:b349965436 , _:b349965437 , _:b349965438 , _:b349965439 , _:b349965408 , _:b349965409 , _:b349965410 , _:b349965411 , _:b349965412 , _:b349965413 , _:b349965414 , _:b349965415 , _:b349965416 , _:b349965417 , _:b349965418 , _:b349965419 , _:b349965420 , _:b349965421 , _:b349965422 , _:b349965423 , _:b349965406 , _:b349965407 ; ns1:pmcid "PMC0" ; bibo:doi "10.1038%2Fsj.bjc.6603719" . @prefix ns4: . ns4:contains _:b2270897 , _:b2270914 , _:b2270916 . _:b2270897 rdf:type ns4:Section . @prefix dc: . _:b2270897 dc:title "results" ; ns4:contains _:b2270898 , _:b2270899 , _:b2270900 , _:b2270901 , _:b2270902 , _:b2270903 , _:b2270904 , _:b2270905 , _:b2270906 , _:b2270907 , _:b2270908 , _:b2270909 , _:b2270910 , _:b2270911 , _:b2270912 , _:b2270913 . _:b2270898 rdf:type ns1:Context ; rdf:value "As there was only one study identified in two comparisons viz., chemoradiation, followed by chemotherapy vs best supportive care (BSC) comparison (Table 2) (Shinchi et al, >>2002<<), and radiotherapy vs chemoradiation, followed by chemotherapy comparison (Table 3) (Moertel et al, 1981), a meta-analysis could not be undertaken for these comparisons." ; ns1:mentions . _:b2270899 rdf:type ns1:Context ; rdf:value "two comparisons viz., chemoradiation, followed by chemotherapy vs best supportive care (BSC) comparison (Table 2) (Shinchi et al, 2002), and radiotherapy vs chemoradiation, followed by chemotherapy comparison (Table 3) (Moertel et al, >>1981<<), a meta-analysis could not be undertaken for these comparisons." ; ns1:mentions . _:b2270900 rdf:type ns1:Context ; rdf:value "In the single randomised controlled trial examined (Shinchi et al, >>2002<<), there was survival advantage for chemoradiation followed by chemotherapy, over BSC (1 trial, 31 patients, HR 0.28; 95% CI 0.13\u20130.60)." ; ns1:mentions . _:b2270901 rdf:type ns1:Context ; rdf:value "There was survival advantage with chemoradiotherapy followed by chemotherapy over radiation alone (1 trial, 56 patients, HR 0.50; 95% CI 0.29\u20130.84) in the trial conducted by Moertel et al (>>1981<<). Time to progression was also better in the chemoradiotherapy followed by chemotherapy arm over radiotherapy alone arm (HR 0.51; 95% CI 0.32\u20130.81)." ; ns1:mentions . _:b2270902 rdf:type ns1:Context ; rdf:value "The agents used for radio sensitisation in the non-5FU arm were different in all three trials, with gemcitabine alone (Li et al, >>2003<<), gemcitabine+cisplatin (Wilkowski et al, 2006) and adriamycin (Gastrointestinal Tumour Study Group, 1985) being used." ; ns1:mentions . _:b2270903 rdf:type ns1:Context ; rdf:value "The agents used for radio sensitisation in the non-5FU arm were different in all three trials, with gemcitabine alone (Li et al, 2003), gemcitabine+cisplatin (Wilkowski et al, >>2006<<) and adriamycin (Gastrointestinal Tumour Study Group, 1985) being used." ; ns1:mentions . _:b2270904 rdf:type ns1:Context ; rdf:value "The agents used for radio sensitisation in the non-5FU arm were different in all three trials, with gemcitabine alone (Li et al, 2003), gemcitabine+cisplatin (Wilkowski et al, 2006) and adriamycin (Gastrointestinal Tumour Study Group, >>1985<<) being used." ; ns1:mentions . _:b2270905 rdf:type ns1:Context ; rdf:value "a significant survival advantage over 5FU-based treatment (HR for 5FU vs Adriamycin=0.97 95% CI 0.73\u20131.29), accompanied by the drawback of significantly increased adverse events (P<0.05) (Gastrointestinal Tumour Study Group, >>1985<<)." ; ns1:mentions . _:b2270906 rdf:type ns1:Context ; rdf:value "chemoradiation (600\u2009mg\u2009m\u22122week\u22121 for 6 weeks), followed by gemcitabine, in comparison to a control arm of 5FU-based chemoradiation (500\u2009mg\u2009m\u22122\u2009day\u22121 for 3 days repeated every 2 weeks for 6 weeks), followed by gemcitabine (Li et al, >>2003<<). Toxicity between the two arms was similar and radiation had been given using three-dimensional conformal radiotherapy." ; ns1:mentions . _:b2270907 rdf:type ns1:Context ; rdf:value "(preliminary results), which did not find improvement in 9 month survival for a group treated with gemcitabine and cisplatin chemoradiation, vs another treated with protracted venous 5-FU infusion chemoradiation (Wilkowski et al, >>2006<<)." ; ns1:mentions . _:b2270908 rdf:type ns1:Context ; rdf:value "Two randomised controlled trials with 168 patients were included in this analysis (Table 5) (Moertel et al, >>1969<<; Cohen et al, 2005). One study described adequate methods of allocation generation, one described adequate methods of concealment, and both described adequate losses to follow-up." ; ns1:mentions . _:b2270909 rdf:type ns1:Context ; rdf:value "Two randomised controlled trials with 168 patients were included in this analysis (Table 5) (Moertel et al, 1969; Cohen et al, >>2005<<). One study described adequate methods of allocation generation, one described adequate methods of concealment, and both described adequate losses to follow-up." ; ns1:mentions . _:b2270910 rdf:type ns1:Context ; rdf:value "Cohen et al (>>2005<<) did not find any difference in disease-free survival (HR 0.77; 95% CI 0.52\u20131.14) or response rate between the two treatments (RR 1.48; 95% CI 0.37\u20135.89)." ; ns1:mentions . _:b2270911 rdf:type ns1:Context ; rdf:value "Four randomised controlled trials (Table 6) with 283 patients were included (Hazel et al, 1981; Klassen et al, >>1985<<; Gastrointestinal Tumour Study Group, 1988; Chauffert et al, 2006), but overall survival data for time-to-event analysis was only available in two studies (134 patients) (Hazel et al, 1981; Klassen et al, 1985)." ; ns1:mentions . _:b2270912 rdf:type ns1:Context ; rdf:value "Four randomised controlled trials (Table 6) with 283 patients were included (Hazel et al, 1981; Klassen et al, 1985; Gastrointestinal Tumour Study Group, >>1988<<; Chauffert et al, 2006), but overall survival data for time-to-event analysis was only available in two studies (134 patients) (Hazel et al, 1981; Klassen et al, 1985)." ; ns1:mentions . _:b2270913 rdf:type ns1:Context ; rdf:value "al, 1981; Klassen et al, 1985; Gastrointestinal Tumour Study Group, 1988; Chauffert et al, 2006), but overall survival data for time-to-event analysis was only available in two studies (134 patients) (Hazel et al, 1981; Klassen et al, >>1985<<). Adequate methods of allocation generation were described in two studies, adequate methods of concealment in one study and adequate losses to follow-up in 3." ; ns1:mentions . _:b2270914 rdf:type ns4:Section ; dc:title "methods" ; ns4:contains _:b2270915 . _:b2270915 rdf:type ns1:Context ; rdf:value "As many trials do not report this information directly (Altman et al, >>1995<<), appropriate data such as log rank test results were extracted to allow estimation of the log HR and its variance using previously reported methods (Parmar et al, 1998; Williamson et al, 2002)." ; ns1:mentions . _:b2270916 rdf:type ns4:Section ; dc:title "discussion" ; ns4:contains _:b2270932 , _:b2270933 , _:b2270934 , _:b2270935 , _:b2270928 , _:b2270929 , _:b2270930 , _:b2270931 , _:b2270940 , _:b2270941 , _:b2270936 , _:b2270937 , _:b2270938 , _:b2270939 , _:b2270917 , _:b2270918 , _:b2270919 , _:b2270924 , _:b2270925 , _:b2270926 , _:b2270927 , _:b2270920 , _:b2270921 , _:b2270922 , _:b2270923 . _:b2270917 rdf:type ns1:Context ; rdf:value "Compared with the Cochrane Collaboration review (Yip et al, 2006), our review excluded two of their studies (Childs et al, >>1965<<; Earle et al, 1994) but included three additional recent randomised controlled trials (Cohen et al, 2005; Chauffert et al, 2006; Wilkowski et al, 2006)." ; ns1:mentions . _:b2270918 rdf:type ns1:Context ; rdf:value "Compared with the Cochrane Collaboration review (Yip et al, 2006), our review excluded two of their studies (Childs et al, 1965; Earle et al, >>1994<<) but included three additional recent randomised controlled trials (Cohen et al, 2005; Chauffert et al, 2006; Wilkowski et al, 2006)." ; ns1:mentions . _:b2270919 rdf:type ns1:Context ; rdf:value "Compared with the Cochrane Collaboration review (Yip et al, 2006), our review excluded two of their studies (Childs et al, 1965; Earle et al, 1994) but included three additional recent randomised controlled trials (Cohen et al, >>2005<<; Chauffert et al, 2006; Wilkowski et al, 2006)." ; ns1:mentions . _:b2270920 rdf:type ns1:Context ; rdf:value "review (Yip et al, 2006), our review excluded two of their studies (Childs et al, 1965; Earle et al, 1994) but included three additional recent randomised controlled trials (Cohen et al, 2005; Chauffert et al, 2006; Wilkowski et al, >>2006<<). The study conducted by Childs et al (1965) was reported in final form by Moertel et al (1969), and hence the exclusion of the duplicate former study, whereas the study by Earle et al (1994) did not fit into the comparisons that were" ; ns1:mentions . _:b2270921 rdf:type ns1:Context ; rdf:value "The study conducted by Childs et al (>>1965<<) was reported in final form by Moertel et al (1969), and hence the exclusion of the duplicate former study, whereas the study by Earle et al (1994) did not fit into the comparisons that were being assessed." ; ns1:mentions . _:b2270922 rdf:type ns1:Context ; rdf:value "The study conducted by Childs et al (1965) was reported in final form by Moertel et al (>>1969<<), and hence the exclusion of the duplicate former study, whereas the study by Earle et al (1994) did not fit into the comparisons that were being assessed." ; ns1:mentions . _:b2270923 rdf:type ns1:Context ; rdf:value "The study conducted by Childs et al (1965) was reported in final form by Moertel et al (1969), and hence the exclusion of the duplicate former study, whereas the study by Earle et al (>>1994<<) did not fit into the comparisons that were being assessed." ; ns1:mentions . _:b2270924 rdf:type ns1:Context ; rdf:value "The basis for incorporating radiation therapy in pancreatic cancer was based on a Mayo clinic randomised controlled trial that randomised patients to receive radiotherapy or 5FU-based radiotherapy (Moertel et al, >>1969<<) and an uncontrolled study of 23 patients who received radiotherapy (5040\u20136680\u2009rad), with 13 patients also receiving 5FU (Haslam et al, 1973)." ; ns1:mentions . _:b2270925 rdf:type ns1:Context ; rdf:value "that randomised patients to receive radiotherapy or 5FU-based radiotherapy (Moertel et al, 1969) and an uncontrolled study of 23 patients who received radiotherapy (5040\u20136680\u2009rad), with 13 patients also receiving 5FU (Haslam et al, >>1973<<). Median survival in the study by Haslam et al (1973) was 7.5 months." ; ns1:mentions . _:b2270926 rdf:type ns1:Context ; rdf:value "Median survival in the study by Haslam et al (>>1973<<) was 7.5 months." ; ns1:mentions . _:b2270927 rdf:type ns1:Context ; rdf:value "One small randomised controlled trial (Shinchi et al, >>2002<<) of 31 patients compared chemoradiation, followed by chemotherapy, to BSC." ; ns1:mentions . _:b2270928 rdf:type ns1:Context ; rdf:value "The regimen of daily 5FU concomitant with radiation differs from all the other randomised controlled trials using chemoradiation (Moertel et al, >>1969<<; Hazel et al, 1981; Klassen et al, 1985; Gastrointestinal Tumour Study Group, 1988; Cohen et al, 2005; Chauffert et al, 2006), wherein weekly 5FU (500\u20131000\u2009mg\u2009m\u22122 given either weekly or on first and last 3 days of radiotherapy) was used" ; ns1:mentions . _:b2270929 rdf:type ns1:Context ; rdf:value "The regimen of daily 5FU concomitant with radiation differs from all the other randomised controlled trials using chemoradiation (Moertel et al, 1969; Hazel et al, 1981; Klassen et al, >>1985<<; Gastrointestinal Tumour Study Group, 1988; Cohen et al, 2005; Chauffert et al, 2006), wherein weekly 5FU (500\u20131000\u2009mg\u2009m\u22122 given either weekly or on first and last 3 days of radiotherapy) was used for radio sensitisation." ; ns1:mentions . _:b2270930 rdf:type ns1:Context ; rdf:value "The regimen of daily 5FU concomitant with radiation differs from all the other randomised controlled trials using chemoradiation (Moertel et al, 1969; Hazel et al, 1981; Klassen et al, 1985; Gastrointestinal Tumour Study Group, >>1988<<; Cohen et al, 2005; Chauffert et al, 2006), wherein weekly 5FU (500\u20131000\u2009mg\u2009m\u22122 given either weekly or on first and last 3 days of radiotherapy) was used for radio sensitisation." ; ns1:mentions . _:b2270931 rdf:type ns1:Context ; rdf:value "of daily 5FU concomitant with radiation differs from all the other randomised controlled trials using chemoradiation (Moertel et al, 1969; Hazel et al, 1981; Klassen et al, 1985; Gastrointestinal Tumour Study Group, 1988; Cohen et al, >>2005<<; Chauffert et al, 2006), wherein weekly 5FU (500\u20131000\u2009mg\u2009m\u22122 given either weekly or on first and last 3 days of radiotherapy) was used for radio sensitisation." ; ns1:mentions . _:b2270932 rdf:type ns1:Context ; rdf:value "Moertel et al (>>1969<<) staged patients using clinical and surgical techniques, whereas Cohen used extensive imaging, in the form of CT scan of abdomen, chest X-ray and bone and brain scan, followed by surgical staging." ; ns1:mentions . _:b2270933 rdf:type ns1:Context ; rdf:value "Moreover, neither radiotherapy nor chemoradiation address the micro metastases present in patients labelled as locally advanced cancer (Liu and Traverso, >>2004<<; Shoup et al, 2004)." ; ns1:mentions . _:b2270934 rdf:type ns1:Context ; rdf:value "Moreover, neither radiotherapy nor chemoradiation address the micro metastases present in patients labelled as locally advanced cancer (Liu and Traverso, 2004; Shoup et al, >>2004<<)." ; ns1:mentions . _:b2270935 rdf:type ns1:Context ; rdf:value "The 1981 GITSG study was instrumental in popularising multimodality therapy in the treatment of locally advanced pancreas cancer, as it showed a doubling of survival duration over radiation alone (Moertel et al, >>1981<<). This was at the price of greater toxicity, as myelosuppression was more frequent and severe, and two cases of gastrointestinal bleeding and one instance of moderate azotemia were reported in the combined modality arm." ; ns1:mentions . _:b2270936 rdf:type ns1:Context ; rdf:value "The GITSG study (Gastrointestinal Tumour Study Group, >>1988<<) utilised 54\u2009Gy, given via three or four fields whereas the Klassen study (Klassen et al, 1985) used 4000\u2009rad given by parallel-opposed anterior and posterior portals." ; ns1:mentions . _:b2270937 rdf:type ns1:Context ; rdf:value "The GITSG study (Gastrointestinal Tumour Study Group, 1988) utilised 54\u2009Gy, given via three or four fields whereas the Klassen study (Klassen et al, >>1985<<) used 4000\u2009rad given by parallel-opposed anterior and posterior portals." ; ns1:mentions . _:b2270938 rdf:type ns1:Context ; rdf:value "Early stoppage of a trial could lead to an erroneous estimation of treatment effects, with a propensity for exaggeration, that is, a random high (Schulz and Grimes, >>2005<<)." ; ns1:mentions . _:b2270939 rdf:type ns1:Context ; rdf:value "which aimed to compare gemcitabine alone to gemcitabine and radiation therapy would have helped settle the issue of whether there is a role, if at all, for multimodality therapy in locally advanced pancreatic cancer (Lockhart et al, >>2005<<). Unfortunately, this trial was closed owing to poor accrual and hence the question remains unanswered (Cardenes et al, 2006)." ; ns1:mentions . _:b2270940 rdf:type ns1:Context ; rdf:value "Unfortunately, this trial was closed owing to poor accrual and hence the question remains unanswered (Cardenes et al, >>2006<<)." ; ns1:mentions . _:b2270941 rdf:type ns1:Context ; rdf:value "Better technology and the use of conformal treatment have led to higher tolerable radiation doses (Yang et al, >>2005<<). With improvements in staging and radiation techniques future studies may re-evaluate the application of upfront chemoradiation or the use of early systemic therapy for the treatment of micro metastases followed by consolidation therapy" ; ns1:mentions . _:b349965406 rdf:type ns1:RelevantBibliographicResource . @prefix xsd: . _:b349965406 ns1:RelevantScore "13"^^xsd:nonNegativeInteger ; ns1:hasRelevantPaperId . _:b349965407 rdf:type ns1:RelevantBibliographicResource ; ns1:RelevantScore "11"^^xsd:nonNegativeInteger ; ns1:hasRelevantPaperId . _:b349965408 rdf:type ns1:RelevantBibliographicResource ; ns1:RelevantScore "11"^^xsd:nonNegativeInteger ; ns1:hasRelevantPaperId . _:b349965409 rdf:type ns1:RelevantBibliographicResource ; ns1:RelevantScore "10"^^xsd:nonNegativeInteger ; ns1:hasRelevantPaperId . _:b349965410 rdf:type ns1:RelevantBibliographicResource ; ns1:RelevantScore "9"^^xsd:nonNegativeInteger ; ns1:hasRelevantPaperId . _:b349965411 rdf:type ns1:RelevantBibliographicResource ; ns1:RelevantScore "8"^^xsd:nonNegativeInteger ; 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