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| Publications [#144321] of Christopher R Kelsey
Papers Published
- CR Kelsey, JW Nelson, CG Willett, JP Chino, RW Clough, JC Bendell, DS Tyler, HI Hurwitz, MA Morse, BM Clary, TN Pappas, BG Czito, Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy.,
International journal of radiation oncology, biology, physics, United States, vol. 69 no. 5
(December, 2007),
pp. 1436-41, ISSN 0360-3016
(last updated on 2008/03/06)
Abstract:
PURPOSE: To report patterns of disease recurrence after resection of adenocarcinoma of the duodenum and compare outcomes between patients undergoing surgery only vs. surgery with concurrent chemotherapy and radiation therapy (CT-RT). METHODS AND MATERIALS: This was a retrospective analysis of all patients undergoing potentially curative therapy for adenocarcinoma of the duodenum at Duke University Medical Center and affiliated hospitals between 1975 and 2005. Overall survival (OS), disease-free survival (DFS), and local control (LC) were estimated using the Kaplan-Meier method. Univariate regression analysis evaluated the effect of CT-RT on clinical endpoints. RESULTS: Thirty-two patients were identified (23 M, 9 F). Median age was 60 years (range, 32-77 years). Surgery alone was performed in 16 patients. An additional 16 patients received either preoperative (n = 11) or postoperative (n = 5) CT-RT. Median RT dose was 50.4 Gy (range, 12.6-54 Gy). All patients treated with RT also received concurrent 5-fluorouracil-based CT. Two patients treated preoperatively had a pathologic complete response (18%), and none had involved lymph nodes at resection. Five-year OS, DFS, and LC for the entire group were 48%, 47%, and 55%, respectively. Five-year survival did not differ between patients receiving CT-RT vs. surgery alone (57% vs. 44%, p = 0.42). However, in patients undergoing R0 resection, CT-RT appeared to improve OS (5-year 83% vs. 53%, p = 0.07). CONCLUSIONS: Local failure after surgery alone is high. Given the patterns of relapse with surgery alone and favorable outcomes in patients undergoing complete resection with CT-RT, the use of CT-RT in selected patients should be considered.
Keywords:
Adenocarcinoma* • Adult • Aged • Antineoplastic Combined Chemotherapy Protocols • Combined Modality Therapy • Disease-Free Survival • Duodenal Neoplasms* • Female • Fluorouracil • Humans • Lymphatic Metastasis • Male • Middle Aged • Neoplasm Recurrence, Local • Radiotherapy Dosage • Regression Analysis • Retrospective Studies • administration & dosage • adverse effects • drug therapy • methods • radiotherapy • secondary • surgery • therapeutic use
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