title: Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum.
abstract: OBJECTIVE
  Adjuvant chemoradiation improves local control and survival in patients with node-positive duodenal adenocarcinoma treated with pancreaticoduodenectomy.
  
  
  METHODS
  A retrospective review of outcomes, with a planned comparison with historical controls.
  
  
  METHODS
  A single, high-volume academic referral center.
  
  
  METHODS
  All patients with periampullary carcinoma treated with pancreaticoduodenectomy and adjuvant chemoradiotherapy at The Johns Hopkins Hospital between 1994 and 2003. Fourteen cases of node-positive duodenal adenocarcinoma were identified. Median radiation dose was 5000 cGy (range, 4000-5760 cGy). Concurrent fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy.
  
  
  RESULTS
  The median follow-up was 12 months for patients who died and 42 months for those who lived. Death occurred in 7 of 14 patients (50%) during the follow-up period. Median survival for all patients was 41 months, and the 5-year survival rate was 44%. Of the 7 patients who experienced disease recurrence, 6 experienced distant metastasis as first recurrence. One of these 7 patients experienced both local recurrence and distant metastasis. Local control for all patients in the study was 93%, which compares favorably with local control reported in a series of patients treated with surgery alone (67%). Compared with historical controls treated with surgery alone, patients who received adjuvant chemoradiation therapy had an improved median survival (21 months vs 41 months, respectively). Overall 5-year survival, however, was not improved (44% vs 43%, respectively).
  
  
  CONCLUSIONS
  Adjuvant chemoradiation therapy after pancreaticoduodenectomy for node-positive duodenal adenocarcinoma may improve local control and median survival but does not impact 5-year overall survival.
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD 21231, USA.
authors: Michael J
authors: MJ
authors: Swartz
authors: Michael A
authors: MA
authors: Hughes
authors: Deborah A
authors: DA
authors: Frassica
authors: Joseph
authors: J
authors: Herman
authors: Charles J
authors: CJ
authors: Yeo
authors: Taylor S
authors: TS
authors: Riall
authors: Keith D
authors: KD
authors: Lillemoe
authors: John L
authors: JL
authors: Cameron
authors: Ross C
authors: RC
authors: Donehower
authors: Daniel A
authors: DA
authors: Laheru
authors: Ralph H
authors: RH
authors: Hruban
authors: Ross A
authors: RA
authors: Abrams
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004379:Duodenal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil