title: Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases.
abstract: BACKGROUND
  Small bowel adenocarcinoma is a rare cancer that has generally been considered resistant to chemotherapy, although little has been published on the role of chemotherapy. A retrospective analysis was conducted of patients with advanced small bowel adenocarcinoma to explore chemotherapy use, and gain knowledge for ongoing management and future clinical trials.
  
  
  METHODS
  All patients with advanced adenocarcinoma of the small bowel treated at Princess Margaret Hospital (PMH) between 1986 and 2004 were identified through the cancer registry. The medical records were reviewed for patient characteristics, treatment and outcome data. Survival statistics were estimated using the Kaplan Meier survival curves and Cox proportional regression model.
  
  
  RESULTS
  Data on 113 patients was reviewed. Forty-four patients received palliative chemotherapy with an overall response rate (ORR) of 36% during a first or second line regimen (9% complete responses and 27% partial responses). Newer chemotherapy regimens including gemcitabine and irinotecan combinations appeared to have higher ORR, than older fluorouracil-based regimens. Some patients responded to more than one line of chemotherapy. Palliative chemotherapy predicted for overall survival (OS) in a multivariate analysis (HR 0.47, P = 0.035).
  
  
  CONCLUSIONS
  Chemotherapy appears to have activity in adenocarcinoma of the small bowel. Prospective trials evaluating patient benefit are required to confirm this activity using newer systemic therapies, until such time retrospective reviews such as this will continue to guide treatment decisions.
authors.affiliation: Department of Hematology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada. paula.fishman@sympatico.ca
authors.forename: Paula N
authors.initials: PN
authors.lastname: Fishman
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.forename: Amit
authors.initials: A
authors.lastname: Oza
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Burkes
authors.forename: Lillian L
authors.initials: LL
authors.lastname: Siu
authors.forename: Ronald
authors.initials: R
authors.lastname: Feld
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Paul
authors.initials: P
authors.lastname: Greig
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome