Adjuvant chemotherapy and radiation for ampullary cancer – pro

Carcinoma of the ampulla of Vater is defined as a malignant tumor arising in the last centimeter of the common bile duct where it passes through the wall of the duodenum and ampullary papilla. The pancreatic duct (of Wirsung) and common bile duct merge and exit by way of the ampulla into the duodenum. The ductal epithelium in these areas is columnar and resembles that of the lower common bile duct. Adenocarcinoma of the ampulla of Vater is a relatively uncommon tumor that accounts for approximately 0.2% of gastrointestinal tract malignancies and approximately 7% of all periampullary carcinomas.When possible, resection is the best treatment. Because local and systemic failures remain problematic, physicians continue to be interested in offering adjuvant therapy. The relative rarity of this disease limits research in this area.

There are many small studies and retrospective reviews that suggest that adjuvant chemoradiation may improve suvival. It is not likely that prospective comparative studies will be performed in this rare disease. A 2008 guidelines says: “As postoperative adjuvant chemotherapy, no effective adjuvant therapy has been established at the present time. It is recommended that further clinical trials, especially large multi-institutional RCTs (phase III studies) using novel agents such as gemcitabine should be performed as soon as possible in order to establish a standard treatment.”

Furuse J, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, Kondo S, Saito H, Tsuyuguchi T, Hirata K, Kimura F, Yoshitomi H, Nozawa S, Yoshida M, Wada K, Amano H, Miura F
Guidelines for chemotherapy of biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008;15(1):55-62

S . Bhatia , R . Miller , M . Haddock , J . Donohue , S . Krishnan Adjuvant therapy for ampullary carcinomas: The Mayo Clinic experience .
International Journal of Radiation OncologyBiologyPhysics , Volume 66 , Issue 2 , Pages 514 – 519

Sunil Krishnan, Vishal Rana, Douglas B Evans, Gauri Varadhachary, Prajnan Das, Sumita Bhatia, Marc E Delclos, Nora A Janjan, Robert A Wolff, Christopher H Crane, Peter W Pisters Role of Adjuvant Chemoradiation Therapy in Adenocarcinomas of the Ampulla of Vater. Int J Radiat Oncol Biol Phys. 2007 Oct 31

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