Heinrich et al. BMC Cancer 2011, 11:346 http://www.biomedcentral.com/1471-2407/11/346 Page 4 of 7 Figure 2 Contrast-enhanced CT (ceCT) shows a tumor-free superior mesenteric artery (sma) [A] and portal vein [B]. In another patient, ceCT suggests tumor infiltration of the celiac trunk [C] and the portal vein confluence [D] (arrows). Follow-up The follow-up is based on physical examination, CA 19- 9 measurement and CT scans of chest and abdomen 9, 12, 15 months after study inclusion and every six months thereafter until disease recurrence. Disease recurrence Any newly appearing lesion with histological documenta- tion of cancer defines recurrent disease. Also, any newly appearing lesion(s) suspicious for malignancy without his- tological documentation but increasing in size upon repeated follow-up exams especially in the context of pro- gressive symptoms (pain, weight loss) or increasing tumor marker (CA 19-9) levels are considered metastases. Also, any newly appearing or progressive soft tissue lesion(s) in the former bed of the pancreatic head suspi- cious for malignancy with either histologic documentation of cancer or increasing size on follow-up exams is consid- ered (local) recurrence. Aim of the study The aim of this study is to test the additional efficacy of neoadjuvant chemotherapy to the standard treatment for resectable cancer of the pancreatic head (surgery + adjuvant chemotherapy). Study endpoints The primary study endpoint is the progression-free sur- vival, which is defined by the date from written informed consent until disease progression or tumor recurrence (local or distant). E.g. the detection of perito- neal metastases during laparoscopy as well as unresect- ability during surgical exploration are considered disease progression.