title: Patterns of failure for stage I ampulla of Vater adenocarcinoma: a single institutional experience.
abstract: BACKGROUND
  Ampullary adenocarcinoma is a rare malignancy associated with a relatively favorable prognosis. Given high survival rates in stage I patients reported in small series with surgery alone, adjuvant chemoradiotherapy (CRT) has traditionally been recommended only for patients with high risk disease. Recent population-based data have demonstrated inferior outcomes to previous series. We examined disease-related outcomes for stage I tumors treated with pancreaticoduodenectomy, with and without CRT.
  
  
  METHODS
  All patients with stage I ampullary adenocarcinoma treated from 1976 to 2011 at Duke University were reviewed. Disease-related endpoints including local control (LC), metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method.
  
  
  RESULTS
  Forty-four patients were included in this study. Thirty-one patients underwent surgery alone, while 13 also received adjuvant CRT. Five-year LC, MFS, DFS and OS for patients treated with surgery only and surgery with CRT were 56% and 83% (P=0.13), 67% and 83% (P=0.31), 56% and 83% (P=0.13), and 53% and 68% (P=0.09), respectively.
  
  
  CONCLUSIONS
  The prognosis for patients diagnosed with stage I ampullary adenocarcinoma may not be as favorable as previously described. Our data suggests a possible benefit of adjuvant CRT delivery.
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Zhong
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Palta
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Willett
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Shannon J
authors.initials: SJ
authors.lastname: McCall
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: McSherry
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Hope E
authors.initials: HE
authors.lastname: Uronis
authors.affiliation: 1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Czito
keywords: Ampulla of Vater; adjuvant therapy; patterns of failure