Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy.
Journal Article (Journal Article;Multicenter Study)
PURPOSE: To report patterns of disease recurrence after resection of adenocarcinoma of the duodenum and compare outcomes between patients undergoing surgery only vs. surgery with concurrent chemotherapy and radiation therapy (CT-RT). METHODS AND MATERIALS: This was a retrospective analysis of all patients undergoing potentially curative therapy for adenocarcinoma of the duodenum at Duke University Medical Center and affiliated hospitals between 1975 and 2005. Overall survival (OS), disease-free survival (DFS), and local control (LC) were estimated using the Kaplan-Meier method. Univariate regression analysis evaluated the effect of CT-RT on clinical endpoints. RESULTS: Thirty-two patients were identified (23 M, 9 F). Median age was 60 years (range, 32-77 years). Surgery alone was performed in 16 patients. An additional 16 patients received either preoperative (n = 11) or postoperative (n = 5) CT-RT. Median RT dose was 50.4 Gy (range, 12.6-54 Gy). All patients treated with RT also received concurrent 5-fluorouracil-based CT. Two patients treated preoperatively had a pathologic complete response (18%), and none had involved lymph nodes at resection. Five-year OS, DFS, and LC for the entire group were 48%, 47%, and 55%, respectively. Five-year survival did not differ between patients receiving CT-RT vs. surgery alone (57% vs. 44%, p = 0.42). However, in patients undergoing R0 resection, CT-RT appeared to improve OS (5-year 83% vs. 53%, p = 0.07). CONCLUSIONS: Local failure after surgery alone is high. Given the patterns of relapse with surgery alone and favorable outcomes in patients undergoing complete resection with CT-RT, the use of CT-RT in selected patients should be considered.
Full Text
Duke Authors
- Chino, Junzo Paul
- Czito, Brian Gary
- Hurwitz, Herbert Ira
- Kelsey, Christopher Ryan
- Morse, Michael Aaron
- Pappas, Theodore N.
- Willett, Christopher G.
Cited Authors
- Kelsey, CR; Nelson, JW; Willett, CG; Chino, JP; Clough, RW; Bendell, JC; Tyler, DS; Hurwitz, HI; Morse, MA; Clary, BM; Pappas, TN; Czito, BG
Published Date
- December 1, 2007
Published In
Volume / Issue
- 69 / 5
Start / End Page
- 1436 - 1441
PubMed ID
- 17689032
International Standard Serial Number (ISSN)
- 0360-3016
Digital Object Identifier (DOI)
- 10.1016/j.ijrobp.2007.05.006
Language
- eng
Conference Location
- United States