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Title: Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct

Abstract

Purpose: To examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival. Methods and Materials: A total of 34 cases of adenocarcinoma of the DCBD were treated with PD and adjuvant chemoradiation at Johns Hopkins Hospital between 1994 and 2003. Median radiation dose was 5,040 cGy (range, 4,000-5,400 cGy). Concurrent 5-fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy. Results: The median follow-up of patients alive at the time of analysis was 41 months. Death occurred in 21 of 34 patients (62%) during the follow-up period, all from progressive, distant metastatic disease. Median overall survival was 36.9 months, with a 5-year survival of 35%. On multivariate analysis, only nodal status significantly predicted survival (p < 0.02). For patients with negative and positive lymph nodes, 5-year survival was 100% and 24%, respectively. Actuarial 5-year local control was 70%. Compared with historical controls who underwent PD alone, patients who underwent surgery and adjuvant chemoradiation had significantly longer survival (36.9 months vs. 22 months; p < 0.05). Overall survival was significantly longer for both lymph node negative and lymph node positive patients (p < 0.05). Conclusions: Adjuvant chemoradiationmore » after PD for adenocarcinoma of the DCBD may improve local control and overall survival. The predominant mode of failure is distant metastatic disease, highlighting the need for improved systemic therapy.« less

Authors:
 [1];  [2];  [3];  [3];  [4];  [3];  [5];  [5];  [6];  [7]
  1. Therapeutic Radiologists, Inc., Kansas City, MO (United States). E-mail: michaelaaronhughes@gmail.com
  2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (United States)
  3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (United States)
  4. Department of Surgery, Indiana School of Medicine, Indianapolis, IN (United States)
  5. Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD (United States)
  6. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (United States)
  7. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States)
Publication Date:
OSTI Identifier:
20951630
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.11.048; PII: S0360-3016(06)03597-8; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BILIARY TRACT; CARCINOMAS; CHEMOTHERAPY; HOSPITALS; LYMPH NODES; METASTASES; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY; URACILS

Citation Formats

Hughes, Michael A., Frassica, Deborah A., Yeo, Charles J., Riall, Taylor S., Lillemoe, Keith D., Cameron, John L., Donehower, Ross C., Laheru, Daniel A., Hruban, Ralph H., and Abrams, Ross A.. Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.11.048.
Hughes, Michael A., Frassica, Deborah A., Yeo, Charles J., Riall, Taylor S., Lillemoe, Keith D., Cameron, John L., Donehower, Ross C., Laheru, Daniel A., Hruban, Ralph H., & Abrams, Ross A.. Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct. United States. doi:10.1016/j.ijrobp.2006.11.048.
Hughes, Michael A., Frassica, Deborah A., Yeo, Charles J., Riall, Taylor S., Lillemoe, Keith D., Cameron, John L., Donehower, Ross C., Laheru, Daniel A., Hruban, Ralph H., and Abrams, Ross A.. Tue . "Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct". United States. doi:10.1016/j.ijrobp.2006.11.048.
@article{osti_20951630,
title = {Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct},
author = {Hughes, Michael A. and Frassica, Deborah A. and Yeo, Charles J. and Riall, Taylor S. and Lillemoe, Keith D. and Cameron, John L. and Donehower, Ross C. and Laheru, Daniel A. and Hruban, Ralph H. and Abrams, Ross A.},
abstractNote = {Purpose: To examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival. Methods and Materials: A total of 34 cases of adenocarcinoma of the DCBD were treated with PD and adjuvant chemoradiation at Johns Hopkins Hospital between 1994 and 2003. Median radiation dose was 5,040 cGy (range, 4,000-5,400 cGy). Concurrent 5-fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy. Results: The median follow-up of patients alive at the time of analysis was 41 months. Death occurred in 21 of 34 patients (62%) during the follow-up period, all from progressive, distant metastatic disease. Median overall survival was 36.9 months, with a 5-year survival of 35%. On multivariate analysis, only nodal status significantly predicted survival (p < 0.02). For patients with negative and positive lymph nodes, 5-year survival was 100% and 24%, respectively. Actuarial 5-year local control was 70%. Compared with historical controls who underwent PD alone, patients who underwent surgery and adjuvant chemoradiation had significantly longer survival (36.9 months vs. 22 months; p < 0.05). Overall survival was significantly longer for both lymph node negative and lymph node positive patients (p < 0.05). Conclusions: Adjuvant chemoradiation after PD for adenocarcinoma of the DCBD may improve local control and overall survival. The predominant mode of failure is distant metastatic disease, highlighting the need for improved systemic therapy.},
doi = {10.1016/j.ijrobp.2006.11.048},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 68,
place = {United States},
year = {Tue May 01 00:00:00 EDT 2007},
month = {Tue May 01 00:00:00 EDT 2007}
}