Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2012 May;19(5):1535-40. doi: 10.1245/s10434-011-2117-1. Epub 2011 Nov 2.
Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. We performed a single-institution outcomes analysis to define the role of concurrent chemoradiotherapy (CRT) in addition to surgery.
A retrospective analysis was performed of all patients undergoing potentially curative pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1976 and 2009. Time-to-event analysis was performed comparing all patients who underwent surgery alone to the cohort of patients receiving CRT in addition to surgery. Local control (LC), disease-free survival (DFS), overall survival (OS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier method.
A total of 137 patients with ampullary carcinoma underwent Whipple procedure. Of these, 61 patients undergoing resection received adjuvant (n = 43) or neoadjuvant (n = 18) CRT. Patients receiving chemoradiotherapy were more likely to have poorly differentiated tumors (P = .03). Of 18 patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response (pCR). With a median follow-up of 8.8 years, 3-year local control was improved in patients receiving CRT (88% vs 55%, P = .001) with trend toward 3-year DFS (66% vs 48%, P = .09) and OS (62% vs 46%, P = .074) benefit in patients receiving CRT.
Long-term survival rates are low and local failure rates high following radical resection alone. Given patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered.
壶腹癌是一种罕见的恶性肿瘤。尽管进行了根治性切除术，但由于局部复发率高，生存率仍然较低。我们进行了一项单机构的结果分析，以确定在手术之外同时进行放化疗（CRT）的作用。
对 1976 年至 2009 年间在杜克大学医院接受胰十二指肠切除术治疗壶腹腺癌的所有患者进行了回顾性分析。对仅接受手术的所有患者与同时接受手术和 CRT 的患者队列进行了时间事件分析。使用 Kaplan-Meier 方法估计局部控制（LC）、无病生存（DFS）、总生存（OS）和无转移生存（MFS）。
共有 137 例壶腹癌患者接受了 Whipple 手术。其中，61 例接受切除术的患者接受了辅助（n = 43）或新辅助（n = 18）CRT。接受放化疗的患者更有可能患有低分化肿瘤（P =.03）。在 18 例接受新辅助治疗的患者中，67%的患者在最终病理上降期，28%的患者达到病理完全缓解（pCR）。中位随访 8.8 年后，接受 CRT 的患者 3 年局部控制得到改善（88%对 55%，P =.001），DFS（66%对 48%，P =.09）和 OS（62%对 46%，P =.074）也有趋势受益。
单独根治性切除术后的长期生存率仍然较低，局部复发率较高。鉴于单独手术时的复发模式和 CRT 患者的局部控制获益，应考虑在选定患者中使用放化疗。
