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Adjuvant Concurrent Chemoradiation for Node-Positive Adenocarcinoma of the Duodenum
Michael J. Swartz, MD;
Michael A. Hughes, MD, MS;
Deborah A. Frassica, MD;
Joseph Herman, MD, MSc;
Charles J. Yeo, MD;
Taylor S. Riall, MD;
Keith D. Lillemoe, MD;
John L. Cameron, MD;
Ross C. Donehower, MD;
Daniel A. Laheru, MD;
Ralph H. Hruban, MD;
Ross A. Abrams, MD
Arch Surg. 2007;142(3):285-288.
Hypothesis Adjuvant chemoradiation improves local control and survival in patients with node-positive duodenal adenocarcinoma treated with pancreaticoduodenectomy.
Design A retrospective review of outcomes, with a planned comparison with historical controls.
Setting A single, high-volume academic referral center.
Patients All patients with periampullary carcinoma treated with pancreaticoduodenectomy and adjuvant chemoradiotherapy at The Johns Hopkins Hospital between 1994 and 2003. Fourteen cases of node-positive duodenal adenocarcinoma were identified. Median radiation dose was 5000 cGy (range, 4000-5760 cGy). Concurrent fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy.
Results The median follow-up was 12 months for patients who died and 42 months for those who lived. Death occurred in 7 of 14 patients (50%) during the follow-up period. Median survival for all patients was 41 months, and the 5-year survival rate was 44%. Of the 7 patients who experienced disease recurrence, 6 experienced distant metastasis as first recurrence. One of these 7 patients experienced both local recurrence and distant metastasis. Local control for all patients in the study was 93%, which compares favorably with local control reported in a series of patients treated with surgery alone (67%). Compared with historical controls treated with surgery alone, patients who received adjuvant chemoradiation therapy had an improved median survival (21 months vs 41 months, respectively). Overall 5-year survival, however, was not improved (44% vs 43%, respectively).
Conclusion Adjuvant chemoradiation therapy after pancreaticoduodenectomy for node-positive duodenal adenocarcinoma may improve local control and median survival but does not impact 5-year overall survival.
Author Affiliations: Departments of Radiation Oncology and Molecular Radiation Sciences (Drs Swartz, Hughes, Frassica, and Herman), Surgery (Drs Yeo, Riall, and Cameron), Medical Oncology (Drs Donehower and Laheru), and Pathology (Dr Hruban), The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Surgery, Indiana School of Medicine, Indianapolis (Dr Lillemoe); and Department of Radiation Oncology, Rush University Medical Center, Chicago, Ill (Dr Abrams).
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