Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater

Jessica Zhou, Charles C. Hsu, Jordan M. Winter, Timothy M. Pawlik, Daniel Laheru, Michael A. Hughes, Ross Donehower, Christopher Wolfgang, Umer Akbar, Richard Schulick, John Cameron, Joseph M. Herman

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: To examine the role of adjuvant chemoradiation (CRT) in patients with resected ampullary adenocarcinoma. Materials and methods: The records of patients who underwent curative surgery for ampullary adenocarcinoma at a single institution between 1992 and 2007 were reviewed. Final analysis included 111 patients, 45% of which also received adjuvant CRT. Results: Median overall survival (OS) was 36.2 months for all patients. Adverse prognostic factors for OS included T stage (T3/4 vs. T1/T2, p = 0.046), node status (positive vs. negative, p < 0.001), and histological grade (grade 3 vs. 1/2, p = 0.09). Patients receiving CRT were more likely to have advanced T-stage (p = 0.001), node positivity (p < 0.001), and poor histologic grade (p = 0.015). Patients who received CRT were also significantly younger (p = 0.001). On univariate analysis, adjuvant CRT failed to result in a significant difference in survival when compared to surgery alone (median OS: 33.4 vs. 36.2 months, p = 0.969). Patients with node-positive resections who underwent CRT had a non-significant improvement in survival (median OS: 21.6 vs. 13.0 months, p = 0.092). Thirty-three percent of patients developed distant metastasis. Common sites of distant metastasis included liver (23%) and peritoneum (7%). Conclusions: Adjuvant chemoradiation following curative resection for ampullary adenocarcinoma did not lead to a statistically significant benefit in overall survival. A significant proportion of patients still developed distant metastatic disease suggesting a need for more effective systemic adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)244-248
Number of pages5
JournalRadiotherapy and Oncology
Volume92
Issue number2
DOIs
StatePublished - Aug 2009

Keywords

  • Adjuvant therapy
  • Ampulla of Vater
  • Ampullary cancer
  • Chemoradiation
  • Radiotherapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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