Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: The Johns Hopkins Hospital - Mayo Clinic collaborative study

Amol K. Narang, Robert C. Miller, Charles C. Hsu, Sumita Bhatia, Timothy M. Pawlik, Dan Laheru, Ralph H. Hruban, Jessica Zhou, Jordan M. Winter, Michael Haddock, John H. Donohue, Richard D. Schulick, Christopher L. Wolfgang, John L. Cameron, Joseph M. Herman

Research output: Contribution to journalArticle

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Abstract

Background: The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Methods: Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n=290; 1992-2007) and at the Mayo Clinic (n=130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n=104 Johns Hopkins, n=82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Results: Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR=1.86, p=0.002), node positive status (RR=3.18, p<0.001), and poor histological grade (RR=1.69, p=0.011). Patients who received adjuvant chemoradiation (n=66) vs. surgery alone (n=120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P<0.001), lymph node involvement (72.7% vs. 30.0%, P<0.001), and close or positive margins (4.6% vs. 0.0%, P=0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5yr OS: 27.5% vs. 5.9%; RR=0.47, P=0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR=0.40, P<0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic disease in the liver or peritoneum. Conclusions: Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.

Original languageEnglish (US)
Pages (from-to)126
Number of pages1
JournalRadiation Oncology
DOIs
StateAccepted/In press - Sep 28 2011

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Adenocarcinoma
Therapeutics
Survival
Fluorouracil
Survival Rate
Carcinoma
Recurrence
Peritoneum
Survival Analysis
Proportional Hazards Models
Liver Diseases
Multivariate Analysis
Lymph Nodes
Radiation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology
  • Medicine(all)

Cite this

Narang, A. K., Miller, R. C., Hsu, C. C., Bhatia, S., Pawlik, T. M., Laheru, D., ... Herman, J. M. (Accepted/In press). Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: The Johns Hopkins Hospital - Mayo Clinic collaborative study. Radiation Oncology, 126. https://doi.org/10.1186/1748-717X-6-126

Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma : The Johns Hopkins Hospital - Mayo Clinic collaborative study. / Narang, Amol K.; Miller, Robert C.; Hsu, Charles C.; Bhatia, Sumita; Pawlik, Timothy M.; Laheru, Dan; Hruban, Ralph H.; Zhou, Jessica; Winter, Jordan M.; Haddock, Michael; Donohue, John H.; Schulick, Richard D.; Wolfgang, Christopher L.; Cameron, John L.; Herman, Joseph M.

In: Radiation Oncology, 28.09.2011, p. 126.

Research output: Contribution to journalArticle

Narang, AK, Miller, RC, Hsu, CC, Bhatia, S, Pawlik, TM, Laheru, D, Hruban, RH, Zhou, J, Winter, JM, Haddock, M, Donohue, JH, Schulick, RD, Wolfgang, CL, Cameron, JL & Herman, JM 2011, 'Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: The Johns Hopkins Hospital - Mayo Clinic collaborative study', Radiation Oncology, pp. 126. https://doi.org/10.1186/1748-717X-6-126
Narang, Amol K. ; Miller, Robert C. ; Hsu, Charles C. ; Bhatia, Sumita ; Pawlik, Timothy M. ; Laheru, Dan ; Hruban, Ralph H. ; Zhou, Jessica ; Winter, Jordan M. ; Haddock, Michael ; Donohue, John H. ; Schulick, Richard D. ; Wolfgang, Christopher L. ; Cameron, John L. ; Herman, Joseph M. / Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma : The Johns Hopkins Hospital - Mayo Clinic collaborative study. In: Radiation Oncology. 2011 ; pp. 126.
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abstract = "Background: The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Methods: Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n=290; 1992-2007) and at the Mayo Clinic (n=130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n=104 Johns Hopkins, n=82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Results: Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4{\%} and 39.1{\%}. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR=1.86, p=0.002), node positive status (RR=3.18, p<0.001), and poor histological grade (RR=1.69, p=0.011). Patients who received adjuvant chemoradiation (n=66) vs. surgery alone (n=120) showed a higher rate of T3/T4 stage disease (57.6{\%} vs. 30.8{\%}, P<0.001), lymph node involvement (72.7{\%} vs. 30.0{\%}, P<0.001), and close or positive margins (4.6{\%} vs. 0.0{\%}, P=0.019). Five year survival rates among node negative and node positive patients were 58.7{\%} and 18.4{\%} respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5yr OS: 27.5{\%} vs. 5.9{\%}; RR=0.47, P=0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR=0.40, P<0.001). Disease relapse occurred in 37.1{\%} of all patients, most commonly metastatic disease in the liver or peritoneum. Conclusions: Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.",
author = "Narang, {Amol K.} and Miller, {Robert C.} and Hsu, {Charles C.} and Sumita Bhatia and Pawlik, {Timothy M.} and Dan Laheru and Hruban, {Ralph H.} and Jessica Zhou and Winter, {Jordan M.} and Michael Haddock and Donohue, {John H.} and Schulick, {Richard D.} and Wolfgang, {Christopher L.} and Cameron, {John L.} and Herman, {Joseph M.}",
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T1 - Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma

T2 - The Johns Hopkins Hospital - Mayo Clinic collaborative study

AU - Narang, Amol K.

AU - Miller, Robert C.

AU - Hsu, Charles C.

AU - Bhatia, Sumita

AU - Pawlik, Timothy M.

AU - Laheru, Dan

AU - Hruban, Ralph H.

AU - Zhou, Jessica

AU - Winter, Jordan M.

AU - Haddock, Michael

AU - Donohue, John H.

AU - Schulick, Richard D.

AU - Wolfgang, Christopher L.

AU - Cameron, John L.

AU - Herman, Joseph M.

PY - 2011/9/28

Y1 - 2011/9/28

N2 - Background: The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Methods: Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n=290; 1992-2007) and at the Mayo Clinic (n=130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n=104 Johns Hopkins, n=82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Results: Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR=1.86, p=0.002), node positive status (RR=3.18, p<0.001), and poor histological grade (RR=1.69, p=0.011). Patients who received adjuvant chemoradiation (n=66) vs. surgery alone (n=120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P<0.001), lymph node involvement (72.7% vs. 30.0%, P<0.001), and close or positive margins (4.6% vs. 0.0%, P=0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5yr OS: 27.5% vs. 5.9%; RR=0.47, P=0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR=0.40, P<0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic disease in the liver or peritoneum. Conclusions: Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.

AB - Background: The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Methods: Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n=290; 1992-2007) and at the Mayo Clinic (n=130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n=104 Johns Hopkins, n=82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Results: Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR=1.86, p=0.002), node positive status (RR=3.18, p<0.001), and poor histological grade (RR=1.69, p=0.011). Patients who received adjuvant chemoradiation (n=66) vs. surgery alone (n=120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P<0.001), lymph node involvement (72.7% vs. 30.0%, P<0.001), and close or positive margins (4.6% vs. 0.0%, P=0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5yr OS: 27.5% vs. 5.9%; RR=0.47, P=0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR=0.40, P<0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic disease in the liver or peritoneum. Conclusions: Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.

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