Duodenal Adenocarcinoma: Patterns of Failure After Resection and the Role of Chemoradiotherapy

Chris R. Kelsey, John W. Nelson, Christopher G. Willett, Junzo P. Chino, Robert W. Clough, Johanna C. Bendell, Douglas S. Tyler, Herbert I. Hurwitz, Michael A. Morse, Bryan M. Clary, Theodore N. Pappas, Brian G. Czito

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60 Scopus citations

Abstract

Purpose: To report patterns of disease recurrence after resection of adenocarcinoma of the duodenum and compare outcomes between patients undergoing surgery only vs. surgery with concurrent chemotherapy and radiation therapy (CT-RT). Methods and Materials: This was a retrospective analysis of all patients undergoing potentially curative therapy for adenocarcinoma of the duodenum at Duke University Medical Center and affiliated hospitals between 1975 and 2005. Overall survival (OS), disease-free survival (DFS), and local control (LC) were estimated using the Kaplan-Meier method. Univariate regression analysis evaluated the effect of CT-RT on clinical endpoints. Results: Thirty-two patients were identified (23 M, 9 F). Median age was 60 years (range, 32-77 years). Surgery alone was performed in 16 patients. An additional 16 patients received either preoperative (n = 11) or postoperative (n = 5) CT-RT. Median RT dose was 50.4 Gy (range, 12.6-54 Gy). All patients treated with RT also received concurrent 5-fluorouracil-based CT. Two patients treated preoperatively had a pathologic complete response (18%), and none had involved lymph nodes at resection. Five-year OS, DFS, and LC for the entire group were 48%, 47%, and 55%, respectively. Five-year survival did not differ between patients receiving CT-RT vs. surgery alone (57% vs. 44%, p = 0.42). However, in patients undergoing R0 resection, CT-RT appeared to improve OS (5-year 83% vs. 53%, p = 0.07). Conclusions: Local failure after surgery alone is high. Given the patterns of relapse with surgery alone and favorable outcomes in patients undergoing complete resection with CT-RT, the use of CT-RT in selected patients should be considered.

Original languageEnglish (US)
Pages (from-to)1436-1441
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume69
Issue number5
DOIs
StatePublished - Dec 1 2007

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Keywords

  • Adenocarcinoma of the duodenum
  • Chemotherapy and radiation therapy
  • Duodenal cancer
  • Patterns of failure

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Kelsey, C. R., Nelson, J. W., Willett, C. G., Chino, J. P., Clough, R. W., Bendell, J. C., Tyler, D. S., Hurwitz, H. I., Morse, M. A., Clary, B. M., Pappas, T. N., & Czito, B. G. (2007). Duodenal Adenocarcinoma: Patterns of Failure After Resection and the Role of Chemoradiotherapy. International Journal of Radiation Oncology Biology Physics, 69(5), 1436-1441. https://doi.org/10.1016/j.ijrobp.2007.05.006