title: Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater.
abstract: OBJECTIVE
  To examine the role of adjuvant chemoradiation (CRT) in patients with resected ampullary adenocarcinoma.
  
  
  METHODS
  The records of patients who underwent curative surgery for ampullary adenocarcinoma at a single institution between 1992 and 2007 were reviewed. Final analysis included 111 patients, 45% of which also received adjuvant CRT.
  
  
  RESULTS
  Median overall survival (OS) was 36.2 months for all patients. Adverse prognostic factors for OS included T stage (T3/4 vs. T1/T2, p=0.046), node status (positive vs. negative, p<0.001), and histological grade (grade 3 vs. 1/2, p=0.09). Patients receiving CRT were more likely to have advanced T-stage (p=0.001), node positivity (p<0.001), and poor histologic grade (p=0.015). Patients who received CRT were also significantly younger (p=0.001). On univariate analysis, adjuvant CRT failed to result in a significant difference in survival when compared to surgery alone (median OS: 33.4 vs. 36.2 months, p=0.969). Patients with node-positive resections who underwent CRT had a non-significant improvement in survival (median OS: 21.6 vs. 13.0 months, p=0.092). Thirty-three percent of patients developed distant metastasis. Common sites of distant metastasis included liver (23%) and peritoneum (7%).
  
  
  CONCLUSIONS
  Adjuvant chemoradiation following curative resection for ampullary adenocarcinoma did not lead to a statistically significant benefit in overall survival. A significant proportion of patients still developed distant metastatic disease suggesting a need for more effective systemic adjuvant therapy.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, 401 N. Broadway, Baltimore, MD 21231, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Zhou
authors.forename: Charles C
authors.initials: CC
authors.lastname: Hsu
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Winter
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Daniel
authors.initials: D
authors.lastname: Laheru
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hughes
authors.forename: Ross
authors.initials: R
authors.lastname: Donehower
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfgang
authors.forename: Umer
authors.initials: U
authors.lastname: Akbar
authors.forename: Richard
authors.initials: R
authors.lastname: Schulick
authors.forename: John
authors.initials: J
authors.lastname: Cameron
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged