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Adjuvant radiotherapy following pancreaticoduodenectomy for ampullary adenocarcinoma improves survival in node-positive patients: a propensity score analysis

Clinical and Translational Oncology volume 20, pages 1212–1218 (2018)Cite this article

Abstract

Introduction

This study aimed to evaluate the impact of adjuvant radiotherapy in patients undergoing pancreaticoduodenectomy (PD) for ampullary adenocarcinoma.

Methods

Using the Surveillance, Epidemiology, and End Results, patients with non-metastatic ampullary adenocarcinoma between 2004 and 2013 were identified. Cancer-specific survival and overall survival were estimated using Kaplan–Meier and Cox regression to obtain adjusted hazard ratio of survival.

Results

In this study, 1106 patients with ampullary adenocarcinoma were identified, of which 27% received adjuvant radiotherapy and the remaining 73% (803/1106) patients did not receive any adjuvant radiotherapy. In the matched cohort, there were still no significant difference in CSS (median 41 vs 35, p = 0.28) and OS (median 32 vs 30, p = 0.26) between patients receiving adjuvant radiotherapy and those under observation alone. However, in patients with N2 (Fig. 4) disease, both CSS (median 27 vs 19 months, p = 0.0044) and OS (median 23 vs 17 months, p = 0.0091) were significantly longer for patients receiving adjuvant radiotherapy.

Conclusion

In summary, adjuvant radiotherapy following PD for ampullary adenocarcinoma significantly improves survival in patients with N2 disease. Future studies defining “high-risk” groups using larger cohorts will enable reliable appraisal on the benefit of adjuvant radiotherapy to allow for a more personalized approach in treating patients.

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References

  1. Rostain F, Hamza S, Drouillard A, Faivre J, Bouvier AM, Lepage C. Trends in incidence and management of cancer of the ampulla of Vater. World J Gastroenterol. 2014;20:10144–50.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sarmiento JM, Nagomey DM, Sarr MG, Farnell MB. Periampullary cancers: are there differences? Surg Clin North Am. 2001;81:543–55.

    Article  PubMed  CAS  Google Scholar 

  3. Willett CG, Warshaw AL, Convery K, Compton CC. Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma. Surg Gynecol Obstet. 1993;176:33–8.

    PubMed  CAS  Google Scholar 

  4. Riall TS, Cameron JL, Lillemoe KD, Winter JM, Campbell KA, Hruban RH, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery. 2006;140:764–72.

    Article  PubMed  Google Scholar 

  5. Hatzaras I, George N, Muscarella P, Melvin WS, Ellison EC, Bloomston M. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol. 2010;17:991–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Neoptolemos JP, Russell RC, Bramhall S, Theis B. Low mortality following resection for pancreatic and periampullary tumors in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg. 1997;84:1370–6.

    Article  PubMed  CAS  Google Scholar 

  7. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308:147–56.

    Article  PubMed  CAS  Google Scholar 

  8. Krishnan S, Rana V, Evans DB, Varadhachary G, Das P, Bhatia S, et al. Role of adjuvant chemoradiotherapy in adenocarcinomas of the ampulla of vater. Int J Radiat Oncol Biol Phys. 2008;70:735–43.

    Article  PubMed  CAS  Google Scholar 

  9. Narang AK, Miller RC, Hsu CC, Bhatia S, Pawlik TM, Laheru D, et al. Evaluation of adjuvant chemoradiotherapy for ampullary adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Radiat Oncol. 2011;6:126.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Palta M, Patel P, Broadwater G, Willett C, Pepek J, Tyler D, et al. Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy. Ann Surg Oncol. 2012;19:1535–40.

    Article  PubMed  Google Scholar 

  11. Zhou J, Hsu CC, Winter JM, Pawlik TM, Laheru D, Hughes MA, et al. Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater. Radiother Oncol. 2009;92:244–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sikora SS, Balachandran P, Dimri K, Rastogi N, Kumar A, Saxena R, et al. Adjuvant chemo-radiotherapy in ampullary cancers. Eur J Surg Oncol. 2005;31:158–63.

    Article  PubMed  CAS  Google Scholar 

  13. Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33:1242–58.

    Article  PubMed  Google Scholar 

  14. Harrell FE Jr, Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143–52.

    Article  PubMed  Google Scholar 

  15. Kim K, Chie EK, Jang JY, Kim SW, Oh DY, Im SA, et al. Role of adjuvant chemoradiotherapy for ampulla of Vater cancer. Int J Radiat Oncol Biol Phys. 2009;75:436–41.

    Article  PubMed  CAS  Google Scholar 

  16. Westgaard A, Tafjord S, Farstad IN, Cvancarova M, Eide TJ, Mathisen O, et al. Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer. 2008;8:170.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

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Affiliations

  1. College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK

    S. K. Kamarajah

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  1. S. K. Kamarajah
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Correspondence to S. K. Kamarajah.

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The author has no conflict of interest.

Research involving human participants and/or animals

This study used a database widely available in the public domain for analyses. All participants in this database were anonymized.

Informed consent

No consent was required for this study, as this study was descriptive and patients were anonymized.

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Kamarajah, S.K. Adjuvant radiotherapy following pancreaticoduodenectomy for ampullary adenocarcinoma improves survival in node-positive patients: a propensity score analysis. Clin Transl Oncol 20, 1212–1218 (2018). https://doi.org/10.1007/s12094-018-1849-9

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  • DOI: https://doi.org/10.1007/s12094-018-1849-9

Keywords

  • Pancreaticoduodenectomy
  • Ampullary carcinoma
  • SEER
  • Outcomes