Role of adjuvant chemoradiotherapy for ampulla of Vater cancer

Int J Radiat Oncol Biol Phys. 2009 Oct 1;75(2):436-41. doi: 10.1016/j.ijrobp.2008.11.067. Epub 2009 Apr 23.


Purpose: To evaluate the role of adjuvant chemoradiotherapy for ampulla of Vater cancer.

Methods and materials: Between January 1991 and December 2002, 118 patients with ampulla of Vater cancer underwent en bloc resection. Forty-one patients received adjuvant chemoradiotherapy [RT(+) group], and 77 did not [RT(-) group]. Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes, for a total dose of up to 40 Gy delivered in 2-Gy fractions, with a planned 2-week rest period halfway through the treatment period. Intravenous 5-fluorouracil (500 mg/m(2)/day) was given on Days 1 to 3 of each split course. The median follow-up was 65 months.

Results: The 5-year overall survival rate in the RT(-) and RT(+) groups was 66.9% and 52.8%, respectively (p = 0.2225). The 5-year locoregional relapse-free survival rate in the RT(-) and RT(+) groups was 79.9% and 80.2%, respectively (p = 0.9582). When age, type of operation, T stage, N stage, histologic differentiation, and the use of adjuvant chemoradiotherapy were incorporated into the Cox proportional hazard model, there was an improvement in the locoregional relapse-free survival rate (p = 0.0050) and a trend toward a longer overall survival (p = 0.0762) associated with the use of adjuvant chemoradiotherapy. Improved overall survival (p = 0.0235) and locoregional relapse-free survival (p = 0.0095) were also evident in patients with nodal metastasis. In contrast, enhanced locoregional control (p = 0.0319) did not result in longer survival in patients with locally advanced disease (p = 0.4544).

Conclusions: Adjuvant chemoradiotherapy may enhance locoregional control and overall survival in patients with ampulla of Vater cancer after curative resection, especially in those with nodal involvement.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Ampulla of Vater*
  • Antimetabolites, Antineoplastic / administration & dosage
  • Chemotherapy, Adjuvant
  • Common Bile Duct Neoplasms / drug therapy*
  • Common Bile Duct Neoplasms / mortality
  • Common Bile Duct Neoplasms / pathology
  • Common Bile Duct Neoplasms / radiotherapy*
  • Common Bile Duct Neoplasms / surgery
  • Disease-Free Survival
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Lymphatic Irradiation
  • Lymphatic Metastasis / radiotherapy
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Proportional Hazards Models
  • Radiotherapy Dosage
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Survival Rate


  • Antimetabolites, Antineoplastic
  • Fluorouracil