Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum.
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.
Swartz
Michael J
MJ
Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD 21231, USA.
Hughes
Michael A
MA
Frassica
Deborah A
DA
Herman
Joseph
J
Yeo
Charles J
CJ
Riall
Taylor S
TS
Lillemoe
Keith D
KD
Cameron
John L
JL
Donehower
Ross C
RC
Laheru
Daniel A
DA
Hruban
Ralph H
RH
Abrams
Ross A
RA
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
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil