Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2015 Jul;17(7):573-9.
doi: 10.1111/hpb.12401. Epub 2015 Mar 20.

Long-term survival after resection for non-pancreatic periampullary cancer followed by adjuvant intra-arterial chemotherapy and concomitant radiotherapy

Joris I Erdmann  1 , Marjolein J M Morak  1 , Hugo J Duivenvoorden  2 , Herman van Dekken  3 , Geert Kazemier  1 , Niels F M Kok  1 , Casper H J van Eijck  1
Affiliations
Randomized Controlled Trial

Long-term survival after resection for non-pancreatic periampullary cancer followed by adjuvant intra-arterial chemotherapy and concomitant radiotherapy

Joris I Erdmann et al. HPB (Oxford). 2015 Jul.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan–Meier curves for overall survival in patients submitted to resection of non-pancreatic periampullary adenocarcinoma with (dotted line) and without (black line) intra-arterial chemotherapy and concomitant radiotherapy (IAC/RT) (log-rank test, P = 0.077; hazard ratio 0.44, 95% confidence interval 0.23–0.83; P = 0.011)
Figure 2
Figure 2
Kaplan–Meier curves for overall survival according to tumour differentiation in patients submitted to resection of well (dotted line), moderate (black line) and poorly (dashed line) differentiated non-pancreatic periampullary adenocarcinoma. Well versus poorly differentiated, P < 0.01; well versus moderately differentiated, P = 0.022; moderately versus poorly differentiated, P = 0.122
Figure 3
Figure 3
Kaplan–Meier curves for disease-free survival in patients submitted to resection of non-pancreatic periampullary adenocarcinoma (NPPC) with (dotted line) and without (black line) intra-arterial chemotherapy and concomitant radiotherapy (IAC/RT) (19 months versus 8 months; log-rank test, P = 0.103; hazard ratio for recurrent disease 0.48, 95% confidence interval 0.25–0.90; P = 0.022)
See this image and copyright information in PMC

References

    1. Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg. 2012;99:1036–1049. - PubMed
    1. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–277. - PubMed
    1. Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246:734–740. - PubMed
    1. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308:147–156. - PubMed
    1. Beger HG, Gansauge F, Buchler MW, Link KH. Intraarterial adjuvant chemotherapy after pancreaticoduodenectomy for pancreatic cancer: significant reduction in occurrence of liver metastasis. World J Surg. 1999;23:946–949. - PubMed

Publication types

MeSH terms