Radiation Oncology/Bile duct/Periampullary

Imaging

• MRI: Korea, 2002 - PMID 12432106 — "Differential diagnosis of periampullary carcinomas at MR imaging." Kim JH et al. Radiographics. 2002 Nov-Dec;22(6):1335-52.

Treatment

• MGH Pattern of Failure Study PMID 8093983 -- Patterns of Failure after pancreaticoduodenectomy for ampullary carcinoma. (Willet CG, Surg Gyne Obstet. 1993 Jan; 176 (1):33-8.)
  • Retrospective. 41 pts with ampullary carcinoma. 69% local control, 55% OS at 5 yrs.
  • Low risk features included limited to ampulla/duodenum, well differentiated, node neg, clear margins. Low risk w/ 100% local control and 80% OS at 5yrs.
  • High risk features included invasion of pancreas,poorly differentiated,+nodes/margins. 50% local control and 38% OS at 5yrs. Xrt appeared to benefit local control in this cohort. Distant mets (liver, peritoneum, pleura) were dominant mode of failure in hi risk group.

• EORTC PMID 10615932 -- Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. (Klinkenbijl JH, Annals of Surgery. 1999 Dec; 230(6):776-82.)
  • Randomized prospective. Included both pancreatic head and peri-ampullary tumors. T1-T3, N0-N1a peri-ampullary allowed. 218 pts total. 45% had peri-ampullary. Randomized to 5FU/xrt vs observation. On subgroup analysis, 2yr OS for peri-ampullary CA was 63% (obs) vs 67% (chemoxrt) p=0.737. No reduction in locoregional recurrence rate was seen in this group.
• Stanford 1995-99 PMID 11146780 -- Adjuvant chemoradiotherapy for "unfavorable" carcinoma of the ampulla of Vater: preliminary report. (2001 Mehta VK, Arch Surg. 2001 Jan;136(1):65-9.)
  • Prospective. 12 patients with "unfavorable" features (+LN, positive margins, poorly differentiated, >2 cm, neurovascular invasion). After surgery, RT 45 Gy + continuous infusion 5-FU. **2-yr OS 89%, MS 34 months, 8/12 disease-free at 2 years.
  • Conclusion: "Adjuvant chemoradiotherapy for carcinoma of the ampulla of Vater is well tolerated and might improve control of this disease in patients with unfavorable features."