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Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum.
Swartz, Michael J; Hughes, Michael A; Frassica, Deborah A; Herman, Joseph; Yeo, Charles J; Riall, Taylor S; Lillemoe, Keith D; Cameron, John L; Donehower, Ross C; Laheru, Daniel A; Hruban, Ralph H; Abrams, Ross A.
Afiliación
  • Swartz MJ; Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD 21231, USA.
Arch Surg ; 142(3): 285-8, 2007 Mar.
Article en En | MEDLINE | ID: mdl-17372054
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.
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Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 6_ODS3_enfermedades_notrasmisibles Problema de salud: 6_digestive_diseases Asunto principal: Adenocarcinoma / Neoplasias Duodenales / Fluorouracilo / Antimetabolitos Antineoplásicos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Arch Surg Año: 2007 Tipo del documento: Article País de afiliación: Estados Unidos
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Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 6_ODS3_enfermedades_notrasmisibles Problema de salud: 6_digestive_diseases Asunto principal: Adenocarcinoma / Neoplasias Duodenales / Fluorouracilo / Antimetabolitos Antineoplásicos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Arch Surg Año: 2007 Tipo del documento: Article País de afiliación: Estados Unidos
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