BACKGROUND: There is no consensus regarding the optimal adjuvant treatment after resection of non-pancreatic periampullary adenocarcinoma (NPPC; distal common bile duct, ampulla, duodenum). OBJECTIVES: The present study was conducted to evaluate the impacts on longterm survival and recurrence of adjuvant intra-arterial chemotherapy (IAC) and concomitant radiotherapy (RT) in patients submitted to resection for NPPC or pancreatic ductal adenocarcinoma (PDAC) in a randomized controlled trial. METHODS: A total of 120 patients with PDAC (n = 62) or NPPC (n = 58) were prestratified at a ratio of 1:1 for tumour origin and randomized. Half of these patients were treated with adjuvant IAC/RT and the other half were treated with surgery alone. Follow-up was completed for all patients up to 5 years after resection or until death. RESULTS: There was no survival benefit in either the whole group (primary endpoint) or the PDAC group after IAC/RT. In the NPPC group, longterm survival was observed in 10 patients in the IAC/RT group and five patients in the control group: median survival was 37 months and 28 months, respectively. The occurrence of liver metastases was reduced by IAC/RT from 57% to 29% (P = 0.038). Cox regression analysis revealed a substantial effect of IAC/RT on survival (hazard ratio: 0.44, 95% confidence interval 0.23-0.83; P = 0.011). CONCLUSIONS: This longterm analysis shows that median and longterm survival were improved after IAC/RT in patients with NPPC, probably because of the effective and sustained reduction of liver metastases. The present results illustrate that NPPC requires an adjuvant approach distinct from that in pancreatic cancer and indicate that further investigation of this issue is warranted.
RCT Entities:
BACKGROUND: There is no consensus regarding the optimal adjuvant treatment after resection of non-pancreatic periampullary adenocarcinoma (NPPC; distal common bile duct, ampulla, duodenum). OBJECTIVES: The present study was conducted to evaluate the impacts on longterm survival and recurrence of adjuvant intra-arterial chemotherapy (IAC) and concomitant radiotherapy (RT) in patients submitted to resection for NPPC or pancreatic ductal adenocarcinoma (PDAC) in a randomized controlled trial. METHODS: A total of 120 patients with PDAC (n = 62) or NPPC (n = 58) were prestratified at a ratio of 1:1 for tumour origin and randomized. Half of these patients were treated with adjuvant IAC/RT and the other half were treated with surgery alone. Follow-up was completed for all patients up to 5 years after resection or until death. RESULTS: There was no survival benefit in either the whole group (primary endpoint) or the PDAC group after IAC/RT. In the NPPC group, longterm survival was observed in 10 patients in the IAC/RT group and five patients in the control group: median survival was 37 months and 28 months, respectively. The occurrence of liver metastases was reduced by IAC/RT from 57% to 29% (P = 0.038). Cox regression analysis revealed a substantial effect of IAC/RT on survival (hazard ratio: 0.44, 95% confidence interval 0.23-0.83; P = 0.011). CONCLUSIONS: This longterm analysis shows that median and longterm survival were improved after IAC/RT in patients with NPPC, probably because of the effective and sustained reduction of liver metastases. The present results illustrate that NPPC requires an adjuvant approach distinct from that in pancreatic cancer and indicate that further investigation of this issue is warranted.
Authors: J H Klinkenbijl; J Jeekel; T Sahmoud; R van Pel; M L Couvreur; C H Veenhof; J P Arnaud; D G Gonzalez; L T de Wit; A Hennipman; J Wils Journal: Ann Surg Date: 1999-12 Impact factor: 12.969
Authors: Amy L Collins; Sylwia Wojcik; James Liu; Wendy L Frankel; Hansjuerg Alder; Lianbo Yu; Thomas D Schmittgen; Carlo M Croce; Mark Bloomston Journal: Ann Surg Oncol Date: 2013-09-18 Impact factor: 5.344
Authors: Helmut Oettle; Peter Neuhaus; Andreas Hochhaus; Jörg Thomas Hartmann; Klaus Gellert; Karsten Ridwelski; Marco Niedergethmann; Carl Zülke; Jörg Fahlke; Michael B Arning; Marianne Sinn; Axel Hinke; Hanno Riess Journal: JAMA Date: 2013-10-09 Impact factor: 56.272
Authors: John P Neoptolemos; Malcolm J Moore; Trevor F Cox; Juan W Valle; Daniel H Palmer; Alexander C McDonald; Ross Carter; Niall C Tebbutt; Christos Dervenis; David Smith; Bengt Glimelius; Richard M Charnley; François Lacaine; Andrew G Scarfe; Mark R Middleton; Alan Anthoney; Paula Ghaneh; Christopher M Halloran; Markus M Lerch; Attila Oláh; Charlotte L Rawcliffe; Caroline S Verbeke; Fiona Campbell; Markus W Büchler Journal: JAMA Date: 2012-07-11 Impact factor: 56.272
Authors: Lei Huang; Yesilda Balavarca; Lydia van der Geest; Valery Lemmens; Liesbet Van Eycken; Harlinde De Schutter; Tom B Johannesen; Vesna Zadnik; Maja Primic-Žakelj; Margit Mägi; Robert Grützmann; Marc G Besselink; Petra Schrotz-King; Hermann Brenner; Lina Jansen Journal: BMC Med Date: 2019-03-25 Impact factor: 8.775