Tumors of ampulla of Vater: A case series and review of chemotherapy options

Table 1 Demographics, histological features, stage, treatment received and outcome of 20 cases of ampullary carcinoma

No.	Age (yr)	Gender	PS	Tumor subtype	Grade	Stage	Adjuvant therapy	Site of failure	First Line Therapy	Response	TTP (mo)	Status	OS (mo)
1	77	F	1	Intestinal	G2	LD	Op + 5FU-CCRT	NA	NA	NA	NA	DOD	14
2	63	M	0	Intestinal	G3	LD	Op + FOLFOX	-----	-----	-----	-----	NED	17
3	45	M	0	Pancreatobiliary	G2	LD	Op + 5FU-CCRT	NA	NA	NA	NA	DOD	48
4	70	M	1	Intestinal	G2	LD	Op	Lymphnodes	CDDP-Gem	PD	11	DOD	20
5	73	F	0	Intestinal	G1	LD	Op	-----		-----	-----	NED	57
6	60	M	1	Intestinal	G2	LD	Op + 5FU-FA	-----	-----	-----	-----	DOO	36
7	73	M	0	Pancreatobiliary	-----	ED		Peritoneal	Gem-Cap	PD	3	DOD	4
8	79	F	2	Pancreatobiliary	-----	LD	Op + Cap-CCRT	-----	-----	-----	-----	NED	22
9	68	F	0	Pancreatobiliary	G2	LD	Op	-----	-----	-----	-----	NED	219
10	83	F	0	Intestinal	G2	LD	Op	-----	-----	-----	-----	NED	41
11	65	M	2	Neuroendocrine	G4	LD	Op + CDDP-VP16	Liver	Topotecan	PD	2	DOD	10
12	68	M	0	Intestinal	G3	LD	Op + FOLFOX	-----	-----	-----	-----	NED	22
13	48	F	1	Intestinal	G3	LD	Op + 5FU-CCRT	Lung	Gem-Oxa	PD	2	DOD	23
14	49	F	1	Intestinal	G1	LD	Op + Cap-CCRT	-----	-----	-----	-----	NED	24
15	71	F	1	Pancreatobiliary	G1	LD	Op	-----	-----	-----	-----	NED	44
16	61	M	0	Pancreatobiliary	G1	LD	Op + Gem + RT	Multiple	5FU	PD	12	DOD	16
17	65	F	2	Intestinal	G3	LD	Op + FOLFOX	Liver	Gem	PD	14	DOD	19
18	79	M	2	Pancreatobiliary	G3	LD	Op	Liver	NA	PD	4	LOF	-----
19	45	F	0	Pancreatobiliary	G3	LD	Op + 5FU-CCRT	Lung	Gem-Oxa	PD	4	DOD	10
20	33	F	0	Intestinal	G1	LD	Op + Cap-CCRT	-----	-----	-----	-----	NED	30

PS: ECOG Performance status; TTP: Time to progression; LD: Limited disease; ED: Extended disease; Op: Operation; CCRT: Concurrent chemoradiotherapy; 5FU: 5-fluorouracil; FA: Folinic acid; OXA: Oxaliplatin; FOLFOX: 5FU + FA + OXA; Cap: Capecitabine; CDDP; Cisplatin; VP16: Etoposide; Gem: Gemcitabine; NA: Not applicable; PD: Progressive disease; DOD: Died of disease; NED: No evidence of disease; DOO: Died of other cause; LOF: Lost of follow-up; OS: Overall survival.

Table 2 Demographics, histological features, stage, treatment received and outcome of patients affected with ampullary or other biliary tract tumors n (%)

	Ampullary tumors (n = 20)	Other biliary tumors (n = 26)	P-value
Gender
Male	9 (45)	10 (38.5)	NS
Female	11 (55)	16 (61.5)
Tumor subtype
Intestinal	11 (55)
Pancreato-biliary	8 (40)
Others	1 (5)
Grade
1-2	11 (55)	7 (66.7)	NS
3-4	7 (45)	5 (33.3)
UICC Stage
I	4 (20)	4 (15.4)	NS
II	10 (50)	10 (38.5)
III	4 (20)	3 (11.5)
IV	2 (10)	9 (34.6)
Surgery	19 (95)	12 (46.1)	< 0.05
Chemotherapy	9 (45)	14 (53.8)	NS
Chemo-radiotherapy	8 (40)	7 (26.9)	NS

NS: Not significant.

Table 3 Studies on adjuvant chemo-radiotherapy

	n	Study design	Treatment group	Control group	Treatment benefit	Author
Pancreatic + periampullary	207	RCT (EORTC)	CCRT	Observation	No	Klinkenbijl et al[36] 1999
Ampullary	104	Retrospective	CCRT	Observation	No	Sikora et al[37] 2005
Ampullary	125	Retrospective	CCRT	Observation	Yes (node+)	Bhatia et al[38] 2006
Pancreatic + periampullary	218	RCT	CCRT	Observation	No	Smeenk et al[39] 2007
Ampullary	96	Retrospective	CCRT	Observation	No	Krishnan et al[40] 2008
Pancreatic + periampullary	120	RCT	CAI + RT	Observation	Yes	Morak et al[41] 2008
Ampullary	118	Retrospective	CCRT	Observation	Yes	Kim et al[42] 2009
Ampullary	111	Retrospective	CCRT	Observation	No	Zhou et al[43] 2009
Extra hepatic biliary cancer	120	Retrospective	CCRT + CT	CCRT	Yes	Lim et al[44] 2009
Ampullary	186	Retrospective	CCRT	Observation	Yes	Narang et al[45] 2011

RCT: Randomized controlled trial; CCRT: Combined chemio-radiotherapy; CAI: Celiac axis infusion (intra-arterial chemotherapy); RT: Radiotherapy; CT: Chemotherapy.