Adjuvant chemo-radiotherapy in ampullary cancers.
OBJECTIVE
Patterns of failure following surgical treatment of ampullary cancers indicate that up to 45% of patients develop loco-regional recurrence. The effect of adjuvant chemo-radiotherapy on survival and loco-regional control is not yet established in this malignancy.


METHODS
From January 1989 to December 2000, 113 patients underwent pancreatico-duodenectomy for ampullary cancer. One hundred and four patients who survived the operation were available for analysis to study the effect of adjuvant chemo-radiotherapy on survival and loco-regional control. Forty-nine patients received adjuvant chemo-radiotherapy (median dose 50.4 Gy with concurrent 5-Flurouracil) and long-term outcome in these patients was compared with those 55 who did not receive adjuvant therapy.


RESULTS
The overall median survival was 30.1 (range 1.6-140.0) months with actuarial 1, 3 and 5-year survival rates of 79, 43 and 33%, respectively. No significant difference in median survival (34.6 vs 24.5 months; P=0.3) and actuarial 5-year survival rates (38 vs 28%) was seen between those who received and those who did not receive adjuvant therapy. Adjuvant chemo-radiotherapy did not influence the survival in high-risk patients (P=0.84), in various T and N stages and had no impact on loco-regional recurrence (P=0.6).


CONCLUSIONS
Adjuvant chemo-radiotherapy did not improve the long-term survival or decrease recurrence rates in patients with ampullary cancers who had undergone pancreatico-duodenectomy.
Sikora
S S
SS
Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014, India. sadiqss@sgpgi.ac.in
Balachandran
P
P
Dimri
K
K
Rastogi
N
N
Kumar
A
A
Saxena
R
R
Kapoor
V K
VK
D000328:Adult; D014670:Ampulla of Vater / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003138:Common Bile Duct Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil