Patterns of failure for stage I ampulla of Vater adenocarcinoma

A single institutional experience

Jim Zhong, Manisha Palta, Christopher G. Willett, Shannon J. McCall, Frances McSherry, Douglas Tyler, Hope E. Uronis, Brian G. Czito

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)421-427
Number of pages7
JournalJournal of Gastrointestinal Oncology
Volume5
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Ampulla of Vater
Adenocarcinoma
Adjuvant Chemoradiotherapy
Chemoradiotherapy
Disease-Free Survival
Neoplasm Metastasis
Pancreaticoduodenectomy
Survival
Neoplasms
Survival Rate

Keywords

  • Adjuvant therapy
  • Ampulla of Vater
  • Patterns of failure

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Patterns of failure for stage I ampulla of Vater adenocarcinoma : A single institutional experience. / Zhong, Jim; Palta, Manisha; Willett, Christopher G.; McCall, Shannon J.; McSherry, Frances; Tyler, Douglas; Uronis, Hope E.; Czito, Brian G.

In: Journal of Gastrointestinal Oncology, Vol. 5, No. 6, 2014, p. 421-427.

Research output: Contribution to journalArticle

Zhong, Jim ; Palta, Manisha ; Willett, Christopher G. ; McCall, Shannon J. ; McSherry, Frances ; Tyler, Douglas ; Uronis, Hope E. ; Czito, Brian G. / Patterns of failure for stage I ampulla of Vater adenocarcinoma : A single institutional experience. In: Journal of Gastrointestinal Oncology. 2014 ; Vol. 5, No. 6. pp. 421-427.
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AB - 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.

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