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.
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.
Authors: Karl Y Bilimoria; David J Bentrem; Jeffrey D Wayne; Clifford Y Ko; Charles L Bennett; Mark S Talamonti Journal: Ann Surg Date: 2009-01 Impact factor: 12.969
Authors: Michael J Overman; Gauri R Varadhachary; Scott Kopetz; Rosni Adinin; E Lin; Jeffrey S Morris; Cathy Eng; James L Abbruzzese; Robert A Wolff Journal: J Clin Oncol Date: 2009-01-21 Impact factor: 44.544