Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater

Radiother Oncol. 2009 Aug;92(2):244-8. doi: 10.1016/j.radonc.2009.05.006. Epub 2009 Jun 21.


Background and purpose: To examine the role of adjuvant chemoradiation (CRT) in patients with resected ampullary adenocarcinoma.

Materials and methods: The records of patients who underwent curative surgery for ampullary adenocarcinoma at a single institution between 1992 and 2007 were reviewed. Final analysis included 111 patients, 45% of which also received adjuvant CRT.

Results: Median overall survival (OS) was 36.2 months for all patients. Adverse prognostic factors for OS included T stage (T3/4 vs. T1/T2, p=0.046), node status (positive vs. negative, p<0.001), and histological grade (grade 3 vs. 1/2, p=0.09). Patients receiving CRT were more likely to have advanced T-stage (p=0.001), node positivity (p<0.001), and poor histologic grade (p=0.015). Patients who received CRT were also significantly younger (p=0.001). On univariate analysis, adjuvant CRT failed to result in a significant difference in survival when compared to surgery alone (median OS: 33.4 vs. 36.2 months, p=0.969). Patients with node-positive resections who underwent CRT had a non-significant improvement in survival (median OS: 21.6 vs. 13.0 months, p=0.092). Thirty-three percent of patients developed distant metastasis. Common sites of distant metastasis included liver (23%) and peritoneum (7%).

Conclusions: Adjuvant chemoradiation following curative resection for ampullary adenocarcinoma did not lead to a statistically significant benefit in overall survival. A significant proportion of patients still developed distant metastatic disease suggesting a need for more effective systemic adjuvant therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater*
  • Combined Modality Therapy
  • Common Bile Duct Neoplasms / mortality
  • Common Bile Duct Neoplasms / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged