Adjuvant Concurrent Chemoradiation for Adenocarcinoma of the Distal Common Bile Duct

Journal Article · Tue May 01 00:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.11.048· OSTI ID:20951630

Hughes, Michael A ^[1]; Frassica, Deborah A ^[2]; Yeo, Charles J ^[3]; Riall, Taylor S ^[3]; Lillemoe, Keith D ^[4]; Cameron, John L ^[3]; Donehower, Ross C ^[5]; Laheru, Daniel A ^[5]; Hruban, Ralph H ^[6]; Abrams, Ross A ^[7]

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1. Therapeutic Radiologists, Inc., Kansas City, MO (United States)
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)

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.

• OSTI ID: 20951630
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 68, 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); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BILIARY TRACT
CARCINOMAS
CHEMOTHERAPY
HOSPITALS
LYMPH NODES
METASTASES
MULTIVARIATE ANALYSIS
PATIENTS
RADIATION DOSES
RADIOTHERAPY
SURGERY
URACILS