title: Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy.
abstract: BACKGROUND
  Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. We performed a single-institution outcomes analysis to define the role of concurrent chemoradiotherapy (CRT) in addition to surgery.
  
  
  METHODS
  A retrospective analysis was performed of all patients undergoing potentially curative pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1976 and 2009. Time-to-event analysis was performed comparing all patients who underwent surgery alone to the cohort of patients receiving CRT in addition to surgery. Local control (LC), disease-free survival (DFS), overall survival (OS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 137 patients with ampullary carcinoma underwent Whipple procedure. Of these, 61 patients undergoing resection received adjuvant (n = 43) or neoadjuvant (n = 18) CRT. Patients receiving chemoradiotherapy were more likely to have poorly differentiated tumors (P = .03). Of 18 patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response (pCR). With a median follow-up of 8.8 years, 3-year local control was improved in patients receiving CRT (88% vs 55%, P = .001) with trend toward 3-year DFS (66% vs 48%, P = .09) and OS (62% vs 46%, P = .074) benefit in patients receiving CRT.
  
  
  CONCLUSIONS
  Long-term survival rates are low and local failure rates high following radical resection alone. Given patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered.
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
authors: Manisha
authors: M
authors: Palta
authors: Pretesh
authors: P
authors: Patel
authors: Gloria
authors: G
authors: Broadwater
authors: Christopher
authors: C
authors: Willett
authors: Joseph
authors: J
authors: Pepek
authors: Douglas
authors: D
authors: Tyler
authors: S Yousuf
authors: SY
authors: Zafar
authors: Hope
authors: H
authors: Uronis
authors: Herbert
authors: H
authors: Hurwitz
authors: Rebekah
authors: R
authors: White
authors: Brian
authors: B
authors: Czito
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome