In contrast to the established role of adjuvant chemotherapy, the benefit of adjuvant chemoradiation (CRT) in resectable PDAC remain controversial. In the absence of level I-II evidence, the ESMO guideline recommends, no CRT should be given to patients after surgery except in clinical trials, while the latest NCCN and ASCO guidelines included adjuvant radiotherapy or CRT as part of integrated therapy following adjuvant chemotherapy in patients who did not receive preoperative therapy and had R1 resection margins or N1 disease. TCOG T3207 study is the first reported randomized trial that was designed to evaluate the role of CRT in patients with resectable PDAC receiving standard six cycles of adjuvant gemcitabine. Despite associated with marginal benefit in reducing loco-regional recurrence (54.1% versus 38.4%, p=0.056), the addition of CRT did not improve the recurrence-free survival (RFS, primary end-point), median RFS: 13.3 months (95% CI 10.0-17.1) versus 12.1 months (95% CI, 9.0-15.8) in GEM alone arm, HR=0.96 (p= 0.80), in patients with resectable PDAC receiving adjuvant gemcitabine. What will be the potential role of CRT in more modern multi-agent adjuvant therapy, such as modified FOLFIRINOX will be discusse
