title: Role of adjuvant chemoradiation therapy in adenocarcinomas of the ampulla of vater.
abstract: OBJECTIVE
  The role of adjuvant chemoradiation therapy (CRT) in the treatment of ampullary cancers remains undefined. We retrospectively compared treatment outcomes in patients treated with pancreaticoduodenectomy alone versus those who received additional adjuvant CRT.
  
  
  METHODS
  Between May 1990 and January 2006, 54 of 96 patients with ampullary adenocarcinoma who underwent potentially curative pancreaticoduodenectomy also received adjuvant CRT. The median preoperative radiation dose was 45 Gy (range, 30-50.4 Gy) and median postoperative dose was 50.4 Gy (range, 45-55.8 Gy). Concurrent chemotherapy included primarily 5-fluorouracil (52%) and capecitabine (43%). Median follow-up was 31 months. Univariate and multivariate statistical methodologies were used to determine significant prognostic factors for local control (LC), distant control (DC), and overall survival (OS).
  
  
  RESULTS
  Actuarial 5-year LC, DC, and OS were 77%, 69%, and 64%, respectively. On univariate analysis, age, gender, race/ethnicity, tumor grade, use of adjuvant treatment, and sequencing of adjuvant therapy were not significantly associated with LC, DC, or OS. However, on univariate analysis, T3/T4 tumor stage was prognostic for poorer LC and OS (p = 0.02 and p < 0.001, respectively); node-positive disease was prognostic for poorer LC (p = 0.03). On multivariate analysis, T3/T4 tumor stage was independently prognostic for decreased OS (p = 0.002). Among these patients (n = 34), those who received adjuvant CRT had a trend toward improved OS (median, 35.2 vs. 16.5 months; p = 0.06).
  
  
  CONCLUSIONS
  Ampullary cancers have a distinctly better treatment outcome than pancreatic adenocarcinomas. Higher primary tumor stage (T3/T4), an independent adverse risk factor for poorer treatment outcomes, may warrant the addition of adjuvant CRT to pancreaticoduodenectomy.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA. skrishnan@manderson.org
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Vishal
authors.initials: V
authors.lastname: Rana
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Gauri
authors.initials: G
authors.lastname: Varadhachary
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Sumita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.forename: Nora A
authors.initials: NA
authors.lastname: Janjan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pisters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil