TABLE 3.

A 70-Year-Old Man With Resected Poorly differentiated Adenocarcinoma of the Pancreatic Head, pT3N0M0 With a Positive Uncinate Margin of Resection and Postoperative CA19–9 = 140

Treatment	Rating	Comments
Observation	1
Chemotherapy alone
5-FU	5	This option may be appropriate but there was disagreement among panel members on the appropriateness rating as defined by the panel’s median rating
Gemcitabine	7
Multiagent chemotherapy	5
Chemoradiation therapy followed by adjuvant chemotherapy	6
Chemotherapy followed by chemoradiation therapy followed by chemotherapy	8
Chemotherapy × 4–6 mo followed by chemoradiation therapy	8
Dose to tumor bed (Gy)
45/1.8	3
50.4/1.8	7
54/1.8	8
59.4/1.8	5	This option is performed with the use of breathing motion management, close attention to bowel dose, and no small bowel in the field
RT technique
AP/PA photons	2
4–5 field photon 3-	7
dimensional conformal plan
IMRT	8
RT volume
Tumor bed alone	5	This option may be appropriate but there was disagreement among panel members on the appropriateness rating as defined by the panel’s median rating
Tumor bed + nodal basin	8

Karnofsky performance status of 80.

Rating Scale: 1, 2, 3 usually not appropriate; 4, 5, 6 may be appropriate; 7, 8, 9 usually appropriate.

AP/PA indicates anterior-posterior/posterior-anterior; 5-FU, 5-fluorouracil; IMRT, intensity-modulated RT; RT, radiation therapy.