When a patient with pancreatic cancer received neoadjuvant chemo + chemo-RT, how do you manage an in-field, post operative positive margin?   

The data from MD Anderson indicates that patients have a similar survival duration when they have an R1 resection after chemoradiation as when they have an R0 resection, and longer than expected with a positive margin. The Mayo Clinic also has data in rectal cancer where there may be an increased ri...

In our institution, we recommend postop adjuvant chemoradiation for a positive margin when a patient has not received neoadjuvant radiation. For patients who have received neoadjuvant radiation, we do not re-irradiate immediately after surgery, instead, we watch and wait and recommend definitive RT ...

I agree with the comments by Dr. @Lin and Dr. @Crane. Other important considerations in this setting pertain to how the surgical margins were assessed for this patient, and, which margins were positive. There is a lot of heterogeneity in how margins have been assessed across centers/studies (Soer an...