Abstract
Purpose
Small bowel adenocarcinoma (SBA) is a rare malignancy with a poor outcome. We evaluated the natural history of SBA at a single Korean institute.
Methods
Medical records of 100 patients with SBA were reviewed for clinical characteristics, treatment patterns, outcomes, and prognostic factors.
Results
The most common primary tumor site was the duodenum (82%). Seventy-four patients were diagnosed with stage III/IV disease (28/46 patients, respectively). Sixty-six patients had surgery (R0/R1/R2 in 32/2/32) without operation-related mortality. Of 34 R0/R1-resected patients, 16 received adjuvant chemotherapy. The dominant pattern of recurrence following R0/R1 resection was distant metastasis (29%; 10 of 34 patients). Thirty-four patients with advanced SBA received palliative chemotherapy, showing a response rate of 27.6% and a median progression-free survival of 3.8 months. The median overall survival for all patients and R0/R1-resected patients was 10.5 and 42.1 months, respectively. In multivariate analysis, lower stage, nonduodenal location, and R0/R1 resection were good independent prognostic factors.
Conclusions
Early diagnosis is crucial to improve outcomes of SBA with respect to increasing resectability. Distant metastasis as a dominant pattern of recurrence suggests a potential role for adjuvant chemotherapy. Newer antitumor agents in advanced SBA should be evaluated considering the poor efficacy of current palliative chemotherapy.
Similar content being viewed by others
References
Agrawal S, McCarron EC, Gibbs JF, Nava HR, Wilding GE, Rajput A (2007) Surgical management and outcome in primary adenocarcinoma of the small bowel. Ann Surg Oncol 14:2263–2269
Aparicio T, Costes L, Moulin V, Locher C, Bidault A, Lecomte T, Mitry E, Taieb J, Landi B, Malka D (2007) Efficacy of recent chemotherapy regimen in advanced small bowel carcinoma. J Clin Oncol 25(18 Suppl): (Abstract 15112)
Barnes G, Romero L, Hess KR, Curley SA (1994) Primary adenocarcinoma of the duodenum: management and survival in 67 patients. Ann Surg Oncol 1:73–78
Bauer RL, Palmer ML, Bauer AM, Nava HR, Douglass HO (1994) Adenocarcinoma of the small intestine: 21-year review of diagnosis, treatment, and prognosis. Ann Surg Oncol 1:183–188
Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS (2009) Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 249:63–71
Chow WH, Linet MS, McLaughlin JK, Hsing AW, Chien HT, Blot WJ (1993) Risk factors for small intestine cancer. Cancer Causes Control 4:163–169
Crawley C, Ross P, Norman A, Hill A, Cunningham D (1998) The Royal Marsden experience of a small bowel adenocarcinoma treated with protracted venous infusion 5-fluorouracil. Br J Cancer 78:508–510
Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J (2004) Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer 101:518–526
Fishman PN, Pond GR, Moore MJ, Oza A, Burkes RL, Siu LL, Feld R, Gallinger S, Greig P, Knox JJ (2006) Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases. Am J Clin Oncol 29:225–231
Gibson MK, Holcroft CA, Kvols LK, Haller D (2005) Phase II study of 5-fluorouracil, doxorubicin, and mitomycin C for metastatic small bowel adenocarcinoma. Oncologist 10:132–137
Greene FL, Balch CM, Page DL (2002) AJCC cancer staging manual. Springer-Verlag, New York
Greenfield LJ, Mulholland MW, Oldham KT (2006) Greenfield’s surgery: scientific principles and practice. Lippincott Williams and Wilkins, Philadelphia
Halfdanarson TR, Quevedo F, McWilliams RR (2006) Small bowel adenocarcinoma: a review of 491 cases. J Clin Oncol 24(18 Suppl): (Abstract 4127)
Hong SH, Koh YH, Rho SY, Byun JH, Oh ST, Im KW, Kim EK, Chang SK (2009) Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome. Jpn J Clin Oncol 39:54–61
Howe JR, Karnell LH, Menck HR, Scott-Conner C (1999) The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985–1995. Cancer 86:2693–2706
Howson CP, Hiyama T, Wynder EL (1986) The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev 8:1–27
Lewis BS, Eisen GM, Friedman S (2005) A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 37:960–965
Martin RG (1986) Malignant tumors of the small intestine. Surg Clin North Am 66:779–785
Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214
Ouriel K, Adams JT (1984) Adenocarcinoma of the small intestine. Am J Surg 147:66–71
Overman MJ, Koptez S, Morris J, Ajani JA, Hoff PM, Abbruzzese JL, Wolff RA (2007) A retrospective review of platinum-based versus non-platinum based chemotherapy in the treatment of metastatic adenocarcinoma of the small bowel (SBA). 2007 Gastrointestinal cancers symposium. (Abstract 172)
Overman MJ, Varadhachary GR, Kopetz S, Adinin R, Lin E, Morris JS, Eng C, Abbruzzese JL, Wolff RA (2009) Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol 27:2598–2603
Pilleul F, Penigaud M, Milot L, Saurin JC, Chayvialle JA, Valette PJ (2006) Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology 241:796–801
Rose DM, Hochwald SN, Klimstra DS, Brennan MF (1996) Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg 183:89–96
Townsend CM, Beauchamp RD, EversSabiston BM, Sabiston DC (2008) Sabiston Textbook of surgery: the biological basis of modern surgical practice. Saunders/Elsevier, Philadelphia
Zollinger RM (1986) Primary neoplasms of the small intestine. Am J Surg 151:654–658
Acknowledgments
This work was supported by a Korea Science and Engineering Foundation (KOSEF) grant (R11-2000-082-02008-0) funded by the Ministry of Science and Technology (MOST), Republic of Korea.
Conflict of interest statement
There are no conflicts of interest for any of the listed authors.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Moon, Y.W., Rha, S.Y., Shin, S.J. et al. Adenocarcinoma of the small bowel at a single Korean institute: management and prognosticators. J Cancer Res Clin Oncol 136, 387–394 (2010). https://doi.org/10.1007/s00432-009-0668-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-009-0668-3