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01-05-2012 | Gastrointestinal Oncology

Carcinoma of the Ampulla of Vater: Patterns of Failure Following Resection and Benefit of Chemoradiotherapy

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

Published in: Annals of Surgical Oncology | Issue 5/2012

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.

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Title: Carcinoma of the Ampulla of Vater: Patterns of Failure Following Resection and Benefit of Chemoradiotherapy
Authors: Manisha Palta, MD
Pretesh Patel, MD
Gloria Broadwater, MS
Christopher Willett, MD
Joseph Pepek, MD
Douglas Tyler, MD
S. Yousuf Zafar, MD
Hope Uronis, MD
Herbert Hurwitz, MD
Rebekah White, MD
Brian Czito, MD
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 5/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-2117-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Carcinoma of the Ampulla of Vater: Patterns of Failure Following Resection and Benefit of Chemoradiotherapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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