Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater.
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.
Zhou
Jessica
J
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, 401 N. Broadway, Baltimore, MD 21231, USA.
Hsu
Charles C
CC
Winter
Jordan M
JM
Pawlik
Timothy M
TM
Laheru
Daniel
D
Hughes
Michael A
MA
Donehower
Ross
R
Wolfgang
Christopher
C
Akbar
Umer
U
Schulick
Richard
R
Cameron
John
J
Herman
Joseph M
JM
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