Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct

Michael A. Hughes, Deborah A. Frassica, Charles J. Yeo, Taylor S. Riall, Keith D. Lillemoe, John L. Cameron, Ross C. Donehower, Daniel A. Laheru, Ralph H. Hruban, Ross A. Abrams

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Purpose: To examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival. Methods and Materials: A total of 34 cases of adenocarcinoma of the DCBD were treated with PD and adjuvant chemoradiation at Johns Hopkins Hospital between 1994 and 2003. Median radiation dose was 5,040 cGy (range, 4,000-5,400 cGy). Concurrent 5-fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy. Results: The median follow-up of patients alive at the time of analysis was 41 months. Death occurred in 21 of 34 patients (62%) during the follow-up period, all from progressive, distant metastatic disease. Median overall survival was 36.9 months, with a 5-year survival of 35%. On multivariate analysis, only nodal status significantly predicted survival (p < 0.02). For patients with negative and positive lymph nodes, 5-year survival was 100% and 24%, respectively. Actuarial 5-year local control was 70%. Compared with historical controls who underwent PD alone, patients who underwent surgery and adjuvant chemoradiation had significantly longer survival (36.9 months vs. 22 months; p < 0.05). Overall survival was significantly longer for both lymph node negative and lymph node positive patients (p < 0.05). Conclusions: Adjuvant chemoradiation after PD for adenocarcinoma of the DCBD may improve local control and overall survival. The predominant mode of failure is distant metastatic disease, highlighting the need for improved systemic therapy.

Original languageEnglish (US)
Pages (from-to)178-182
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume68
Issue number1
DOIs
StatePublished - May 1 2007
Externally publishedYes

Fingerprint

Common Bile Duct
ducts
Adenocarcinoma
Pancreaticoduodenectomy
Survival
lymphatic system
Lymph Nodes
chemotherapy
Maintenance Chemotherapy
death
surgery
Fluorouracil
maintenance
radiation therapy
therapy
Radiotherapy
Multivariate Analysis
Radiation
Drug Therapy
dosage

Keywords

  • Adenocarcinoma
  • Chemotherapy
  • Distal common bile duct
  • Pancreaticoduodenectomy
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Hughes, M. A., Frassica, D. A., Yeo, C. J., Riall, T. S., Lillemoe, K. D., Cameron, J. L., ... Abrams, R. A. (2007). Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct. International Journal of Radiation Oncology Biology Physics, 68(1), 178-182. https://doi.org/10.1016/j.ijrobp.2006.11.048

Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct. / Hughes, Michael A.; Frassica, Deborah A.; Yeo, Charles J.; Riall, Taylor S.; Lillemoe, Keith D.; Cameron, John L.; Donehower, Ross C.; Laheru, Daniel A.; Hruban, Ralph H.; Abrams, Ross A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 68, No. 1, 01.05.2007, p. 178-182.

Research output: Contribution to journalArticle

Hughes, MA, Frassica, DA, Yeo, CJ, Riall, TS, Lillemoe, KD, Cameron, JL, Donehower, RC, Laheru, DA, Hruban, RH & Abrams, RA 2007, 'Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct', International Journal of Radiation Oncology Biology Physics, vol. 68, no. 1, pp. 178-182. https://doi.org/10.1016/j.ijrobp.2006.11.048
Hughes, Michael A. ; Frassica, Deborah A. ; Yeo, Charles J. ; Riall, Taylor S. ; Lillemoe, Keith D. ; Cameron, John L. ; Donehower, Ross C. ; Laheru, Daniel A. ; Hruban, Ralph H. ; Abrams, Ross A. / Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 68, No. 1. pp. 178-182.
@article{8a1fa2a64fee452193fa6cac0414a75a,
title = "Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct",
abstract = "Purpose: To examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival. Methods and Materials: A total of 34 cases of adenocarcinoma of the DCBD were treated with PD and adjuvant chemoradiation at Johns Hopkins Hospital between 1994 and 2003. Median radiation dose was 5,040 cGy (range, 4,000-5,400 cGy). Concurrent 5-fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy. Results: The median follow-up of patients alive at the time of analysis was 41 months. Death occurred in 21 of 34 patients (62{\%}) during the follow-up period, all from progressive, distant metastatic disease. Median overall survival was 36.9 months, with a 5-year survival of 35{\%}. On multivariate analysis, only nodal status significantly predicted survival (p < 0.02). For patients with negative and positive lymph nodes, 5-year survival was 100{\%} and 24{\%}, respectively. Actuarial 5-year local control was 70{\%}. Compared with historical controls who underwent PD alone, patients who underwent surgery and adjuvant chemoradiation had significantly longer survival (36.9 months vs. 22 months; p < 0.05). Overall survival was significantly longer for both lymph node negative and lymph node positive patients (p < 0.05). Conclusions: Adjuvant chemoradiation after PD for adenocarcinoma of the DCBD may improve local control and overall survival. The predominant mode of failure is distant metastatic disease, highlighting the need for improved systemic therapy.",
keywords = "Adenocarcinoma, Chemotherapy, Distal common bile duct, Pancreaticoduodenectomy, Radiotherapy",
author = "Hughes, {Michael A.} and Frassica, {Deborah A.} and Yeo, {Charles J.} and Riall, {Taylor S.} and Lillemoe, {Keith D.} and Cameron, {John L.} and Donehower, {Ross C.} and Laheru, {Daniel A.} and Hruban, {Ralph H.} and Abrams, {Ross A.}",
year = "2007",
month = "5",
day = "1",
doi = "10.1016/j.ijrobp.2006.11.048",
language = "English (US)",
volume = "68",
pages = "178--182",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct

AU - Hughes, Michael A.

AU - Frassica, Deborah A.

AU - Yeo, Charles J.

AU - Riall, Taylor S.

AU - Lillemoe, Keith D.

AU - Cameron, John L.

AU - Donehower, Ross C.

AU - Laheru, Daniel A.

AU - Hruban, Ralph H.

AU - Abrams, Ross A.

PY - 2007/5/1

Y1 - 2007/5/1

N2 - Purpose: To examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival. Methods and Materials: A total of 34 cases of adenocarcinoma of the DCBD were treated with PD and adjuvant chemoradiation at Johns Hopkins Hospital between 1994 and 2003. Median radiation dose was 5,040 cGy (range, 4,000-5,400 cGy). Concurrent 5-fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy. Results: The median follow-up of patients alive at the time of analysis was 41 months. Death occurred in 21 of 34 patients (62%) during the follow-up period, all from progressive, distant metastatic disease. Median overall survival was 36.9 months, with a 5-year survival of 35%. On multivariate analysis, only nodal status significantly predicted survival (p < 0.02). For patients with negative and positive lymph nodes, 5-year survival was 100% and 24%, respectively. Actuarial 5-year local control was 70%. Compared with historical controls who underwent PD alone, patients who underwent surgery and adjuvant chemoradiation had significantly longer survival (36.9 months vs. 22 months; p < 0.05). Overall survival was significantly longer for both lymph node negative and lymph node positive patients (p < 0.05). Conclusions: Adjuvant chemoradiation after PD for adenocarcinoma of the DCBD may improve local control and overall survival. The predominant mode of failure is distant metastatic disease, highlighting the need for improved systemic therapy.

AB - Purpose: To examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival. Methods and Materials: A total of 34 cases of adenocarcinoma of the DCBD were treated with PD and adjuvant chemoradiation at Johns Hopkins Hospital between 1994 and 2003. Median radiation dose was 5,040 cGy (range, 4,000-5,400 cGy). Concurrent 5-fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy. Results: The median follow-up of patients alive at the time of analysis was 41 months. Death occurred in 21 of 34 patients (62%) during the follow-up period, all from progressive, distant metastatic disease. Median overall survival was 36.9 months, with a 5-year survival of 35%. On multivariate analysis, only nodal status significantly predicted survival (p < 0.02). For patients with negative and positive lymph nodes, 5-year survival was 100% and 24%, respectively. Actuarial 5-year local control was 70%. Compared with historical controls who underwent PD alone, patients who underwent surgery and adjuvant chemoradiation had significantly longer survival (36.9 months vs. 22 months; p < 0.05). Overall survival was significantly longer for both lymph node negative and lymph node positive patients (p < 0.05). Conclusions: Adjuvant chemoradiation after PD for adenocarcinoma of the DCBD may improve local control and overall survival. The predominant mode of failure is distant metastatic disease, highlighting the need for improved systemic therapy.

KW - Adenocarcinoma

KW - Chemotherapy

KW - Distal common bile duct

KW - Pancreaticoduodenectomy

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=34247138749&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247138749&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2006.11.048

DO - 10.1016/j.ijrobp.2006.11.048

M3 - Article

VL - 68

SP - 178

EP - 182

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 1

ER -