title: Adjuvant therapy for ampullary carcinomas: the Mayo Clinic experience.
abstract: OBJECTIVE
  To determine the effects of adjuvant radiotherapy and chemotherapy for carcinoma of the ampulla of Vater.
  
  
  METHODS
  We retrospectively reviewed the records of 125 patients who underwent definitive surgery for carcinomas involving the ampulla of Vater between April 1977 and February 2005 and who survived more than 50 days after surgery. Twenty-nine of the patients also received adjuvant radiotherapy (median dose, 50.4 Gy in 28 fractions) with concurrent 5-fluorouracil chemotherapy. Adverse prognostic factors were investigated, and overall survival (OS) and local and distant failure were estimated.
  
  
  RESULTS
  Adverse prognostic factors for decreased OS by univariate analysis included lymph node (LN) involvement, locally advanced tumors (T3/T4), and poor histologic grade. By multivariate analysis, positive LN status (p=0.02) alone was associated with decreased OS. The addition of adjuvant radiotherapy and chemotherapy improved OS for patients with positive LN (p=0.01). Median survival for positive LN patients receiving adjuvant therapy was 3.4 years, vs. 1.6 years for those with surgery alone.
  
  
  CONCLUSIONS
  The addition of adjuvant radiotherapy and 5-fluorouracil chemotherapy may improve OS in patients with LN involvement. The effect of adjuvant therapy on outcomes for patients with poor histologic grade or T3/T4 tumors without LN involvement could not be assessed.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Sumita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: John H
authors.initials: JH
authors.lastname: Donohue
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000704:Analysis of Variance; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil