Faculty Collaboration Database

Defining the role of adjuvant external beam radiotherapy on resected adenocarcinoma of the ampulla of vater. J Gastrointest Surg 2014 Nov;18(11):2003-8

Date

08/28/2014

Pubmed ID

25159502

DOI

10.1007/s11605-014-2629-7

Scopus ID

2-s2.0-84920163240 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

The role of adjuvant radiotherapy in the treatment of ampullary carcinoma (AC) remains unclear. We hypothesized that adjuvant radiotherapy (RT) does not improve survival following resection for AC. The SEER database was queried for patients with non-metastatic AC who underwent surgery (S) from 2004 to 2010. Propensity score (PS) modeling was applied to create balanced cohorts of patients that would be equally likely to receive RT. Cox proportional hazard models were used to compare survival. Of 1,287 patients, 329 (25.6%) received adjuvant RT. Unadjusted median overall survival (OS) for patients receiving adjuvant RT compared to S alone was 27 vs. 36 months (p = 0.14). Patients receiving RT were younger (63 vs. 69 years, p < 0.001), had more advanced tumors (69 vs. 53% T3/T4, p < 0.001), and had more frequent lymph node metastasis (73 vs. 40%, p < 0.001). Adjuvant RT failed to improve both overall survival (27 vs. 29 months, p = 0.58) and disease-specific survival (36 vs. 40 months, p = 0.92) in propensity-matched cohorts, although certain imbalances remained between treatment groups. Adjuvant RT does not confer a survival benefit for patients with ampullary tumors. The lack of disease-specific survival benefit suggests that it may also not be beneficial to prevent local recurrences.

Author List

Miura JT, Jayakrishnan TT, Amini A, Johnston FM, Tsai S, Erickson B, Quebbeman EJ, Christians KK, Evans DB, Gamblin TC, Turaga KK

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Ampulla of Vater
Cohort Studies
Common Bile Duct Neoplasms
Confidence Intervals
Disease-Free Survival
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
Propensity Score
Radiotherapy, Adjuvant
Retrospective Studies
Role
SEER Program
Survival Analysis
Treatment Outcome
Young Adult