Carcinoma of the ampulla of vater

Patterns of failure following resection and benefit of chemoradiotherapy

Manisha Palta, Pretesh Patel, Gloria Broadwater, Christopher Willett, Joseph Pepek, Douglas Tyler, S. Yousuf Zafar, Hope Uronis, Herbert Hurwitz, Rebekah White, Brian Czito

Research output: Contribution to journalArticle

25 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1535-1540
Number of pages6
JournalAnnals of Surgical Oncology
Volume19
Issue number5
DOIs
StatePublished - May 2012
Externally publishedYes

Fingerprint

Ampulla of Vater
Chemoradiotherapy
Carcinoma
Disease-Free Survival
Survival
Survival Rate
Neoadjuvant Therapy
Pancreaticoduodenectomy
Neoplasms
Adenocarcinoma

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Carcinoma of the ampulla of vater : Patterns of failure following resection and benefit of chemoradiotherapy. / Palta, Manisha; Patel, Pretesh; Broadwater, Gloria; Willett, Christopher; Pepek, Joseph; Tyler, Douglas; Zafar, S. Yousuf; Uronis, Hope; Hurwitz, Herbert; White, Rebekah; Czito, Brian.

In: Annals of Surgical Oncology, Vol. 19, No. 5, 05.2012, p. 1535-1540.

Research output: Contribution to journalArticle

Palta, M, Patel, P, Broadwater, G, Willett, C, Pepek, J, Tyler, D, Zafar, SY, Uronis, H, Hurwitz, H, White, R & Czito, B 2012, 'Carcinoma of the ampulla of vater: Patterns of failure following resection and benefit of chemoradiotherapy', Annals of Surgical Oncology, vol. 19, no. 5, pp. 1535-1540. https://doi.org/10.1245/s10434-011-2117-1
Palta, Manisha ; Patel, Pretesh ; Broadwater, Gloria ; Willett, Christopher ; Pepek, Joseph ; Tyler, Douglas ; Zafar, S. Yousuf ; Uronis, Hope ; Hurwitz, Herbert ; White, Rebekah ; Czito, Brian. / Carcinoma of the ampulla of vater : Patterns of failure following resection and benefit of chemoradiotherapy. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 5. pp. 1535-1540.
@article{dbd977c7415848c88828afb960e15b00,
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.",
author = "Manisha Palta and Pretesh Patel and Gloria Broadwater and Christopher Willett and Joseph Pepek and Douglas Tyler and Zafar, {S. Yousuf} and Hope Uronis and Herbert Hurwitz and Rebekah White and Brian Czito",
year = "2012",
month = "5",
doi = "10.1245/s10434-011-2117-1",
language = "English (US)",
volume = "19",
pages = "1535--1540",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Carcinoma of the ampulla of vater

T2 - Patterns of failure following resection and benefit of chemoradiotherapy

AU - Palta, Manisha

AU - Patel, Pretesh

AU - Broadwater, Gloria

AU - Willett, Christopher

AU - Pepek, Joseph

AU - Tyler, Douglas

AU - Zafar, S. Yousuf

AU - Uronis, Hope

AU - Hurwitz, Herbert

AU - White, Rebekah

AU - Czito, Brian

PY - 2012/5

Y1 - 2012/5

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84862560754&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862560754&partnerID=8YFLogxK

U2 - 10.1245/s10434-011-2117-1

DO - 10.1245/s10434-011-2117-1

M3 - Article

VL - 19

SP - 1535

EP - 1540

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 5

ER -