title: Defining the role of adjuvant external beam radiotherapy on resected adenocarcinoma of the ampulla of vater.
abstract: The role of adjuvant radiotherapy in the treatment of ampullary carcinoma (AC) remains unclear. We hypothesized that adjuvant radiotherapy (RT) does not improve survival following resection for AC. The SEER database was queried for patients with non-metastatic AC who underwent surgery (S) from 2004 to 2010. Propensity score (PS) modeling was applied to create balanced cohorts of patients that would be equally likely to receive RT. Cox proportional hazard models were used to compare survival. Of 1,287 patients, 329 (25.6%) received adjuvant RT. Unadjusted median overall survival (OS) for patients receiving adjuvant RT compared to S alone was 27 vs. 36 months (p = 0.14). Patients receiving RT were younger (63 vs. 69 years, p < 0.001), had more advanced tumors (69 vs. 53% T3/T4, p < 0.001), and had more frequent lymph node metastasis (73 vs. 40%, p < 0.001). Adjuvant RT failed to improve both overall survival (27 vs. 29 months, p = 0.58) and disease-specific survival (36 vs. 40 months, p = 0.92) in propensity-matched cohorts, although certain imbalances remained between treatment groups. Adjuvant RT does not confer a survival benefit for patients with ampullary tumors. The lack of disease-specific survival benefit suggests that it may also not be beneficial to prevent local recurrences.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI, 53226, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Miura
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.forename: Albert
authors.initials: A
authors.lastname: Amini
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Quebbeman
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D057216:Propensity Score; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D012380:Role; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult