Neoadjuvant Chemoradiation Therapy in Nonpancreatic Periampullary Carcinoma: An Institutional Experience

Abstract

Periampullary adenocarcinomas are neoplasms that arise in the pancreatic ducts, distal bile duct, ampulla or duodenum. Non-pancreatic periampullary tumors are a rare and heterogeneous group of neoplasms with no clearly defined standard of care. Despite resection, local failure rates are high in these patients and the role of radiation therapy is poorly defined. We analyzed all patients with potentially resectable, non-pancreatic periampullary carcinomas who underwent neoadjuvant chemoradiation at our institution from 1980 through 2015. Study endpoints included treatment-related toxicity, pathological complete response (pCR), rates of curative (R0) resection, post-operative complications rates, overall survival, disease-free survival as well as locoregional control rates Sixty-three patients were included with 54 undergoing potentially curative surgical resection. Ninety-eight percent of patients completed their planned treatment. Eleven patients (17%) experienced Grade 3 GI toxicity with no Grade 4 GI toxicity, while 3 patients experienced Grade 3 hematological toxicity and no Grade 4 toxicity. Among surgical patients, 49 patients (91%) underwent R0 resection and eleven patients (20%) achieved pCR. With a median follow up of 53.5 months, 5-year overall, disease-free and locoregional recurrence-free survival rates were 58%, 34% and 40% respectively in surgical patients. Median locoregional recurrence-free, disease-free and overall survival rates were not reached, 21.8 months and 38.8 months, respectively. Neoadjuvant chemoradiation therapy for non-pancreatic periampullary carcinomas is safe, reasonably well tolerated and associated with high rates of compliance, RO resection and pCR. In absence of level I evidence, our experience suggests that neoadjuvant chemoradiation should be considered in this group of patients and a topic of further investigation.