Adenocarcinoma of the duodenum: Factors influencing survival

Rotman, N; Pezet, Denis; Fagniez, P.-L.; Cherqui, Daniel; Celicout, B; Lointier, Patrice

doi:10.1002/bjs.1800810128

Cited by 64 publications

(64 citation statements)

References 15 publications

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“…Only one patient experienced a treatment-related deterioration in PS, other patients maintained a PS of 2. Although the series is small, the results in terms of overall survival, symptomatic responses, the improvement or maintenance of a good PS as an indicator of quality of life and the generally low toxicity of therapy, suggests that there may be benefit of 5FU-based chemotherapy compared with palliative surgery alone (Sakker and Ware, 1973;Rotman et al, 1994). Various series or case reports have suggested that small bowel adenocarcinoma is a chemo-or radiosensitive disease, particularly in comparison with pancreatic cancer (Sakker and Ware, 1973;Jigyasu et al, 1984;Okhusa et al, 1991;Yeung et al, 1993;Coia et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

The Royal Marsden experience of small bowel adenocarcinoma treated with protracted venous infusion 5-fluorouracil

Crawley

Ross²,

Norman³

et al. 1998

Br J Cancer

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Summary The purpose of this study was to review the efficacy of a protracted venous infusion of 5-fluorouracil (PVI 5-FU)-based chemotherapy in advanced small bowel adenocarcinoma. Data on all patients with small bowel malignancy who were seen at a single institution over a 5-year period were retrieved from the gastrointestinal unit and hospital databases, and these cases were reviewed. Eight patients with advanced small bowel adenocarcinoma received PVI 5FU-based chemotherapy. The overall response rate in assessable patients was 37.5% (3/8). The median overall survival was 13 months (range 1-28), and progression-free survival was 7.8 months (range 0-15). Overall, the treatment was well tolerated and symptomatic benefit was seen. In conclusion, PVI 5-FU has activity in this disease. This should be assessed either as a single agent or as part of a combination regimen such as epirubicin/cisplatin/PVI FU (ECF) in a multicentre randomized study.Keywords: small intestine; adenocarcinoma; 5-fluorouracil; infusional treatment Although adenocarcinoma is the most common small bowel tumour, it still represents less than 1% of gastrointestinal (GI) tract tumours. The standard treatment is surgery with a resection rate of 35-77%. The operative mortality of surgery with a curative intent is 0-18% and the 5-year survival is 10-62% (Delcore et al, 1993;Ouriel and Adams, 1984). The role of radiotherapy and chemotherapy is less clear. There are reports of prolonged survival with combination chemo-and radiotherapy following palliative bypass surgery or incomplete resection and reports suggesting a better prognosis compared with pancreatic carcinoma (Sakker and Ware, 1973;Yeung et al, 1993). Data on the use of chemotherapy alone are limited. Regimens used have been very varied, and some series have been collected over prolonged periods (Sakker and Ware, 1973;Okhusa et al, 1991). METHODSThe GI unit and hospital databases were searched for patients referred to the Royal Marsden Hospital (RMH) with malignancy of the small bowel during the period 1990-95. Pathology was reviewed at RMH before treatment. Data regarding diagnosis, treatment, toxicity and response were collected prospectively. Responses were assessed according to the WHO criteria (Miller et al, 1981). Symptomatic responses were recorded prospectively on the GI database; improvement was defined as disappearance of a symptom for >3 weeks.

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Section: Discussionmentioning

confidence: 99%

The Royal Marsden experience of small bowel adenocarcinoma treated with protracted venous infusion 5-fluorouracil

Crawley

Ross²,

Norman³

et al. 1998

Br J Cancer

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“…Nenhum de nossos pacientes apresentou icterícia, que é relatada em até 54% dos enfermos 16,19,20 . Apenas a portadora de adenocarcinoma viloso da segunda porção teve surtos de pancreatite aguda, sem icterícia.…”

Section: Discussionunclassified

“…A GDPC, não obstante seu vulto, é o melhor tratamento para as neoplasias da segunda porção duodenal, opinião que é corroborada pela maioria dos autores 2,7,17,19,20,21 . Mesmo a presença de metástases linfonodais parece não ter impacto na sobrevida dos enfermos e não deve contra-indicar a ressecção 2,23 .…”

Section: Discussionunclassified

“…Mesmo a presença de metástases linfonodais parece não ter impacto na sobrevida dos enfermos e não deve contra-indicar a ressecção 2,23 . A GDPC, assim, deve ser o procedimento de escolha no tratamento dos adenocarcinomas do duodeno, sempre que tecnicamente exeqüível e que as condições clínicas permitirem, ainda que na presença de metástases linfonodais regionais 20 .…”

Section: Discussionunclassified

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Neoplasias duodenais primárias: análise de casuística e conduta cirúrgica

Bromberg¹,

Júnior

Goffi³

et al. 2000

Rev. Col. Bras. Cir.

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São apresentados 18 casos de neoplasias primárias do duodeno, salientando-se sua raridade e as dificuldades diagnósticas, a despeito dos modernos recursos endoscópicos e de identificação por imagem. A literatura revela que de 1% a 10% de todos os tumores do aparelho digestório se situam no intestino delgado. A localização duodenal é, por isso, muito pouco freqüente, possui sintomatologia indefinida e implica conduta terapêutica mais complexa do que quando o tumor se situa em outros segmentos do intestino delgado. Os sintomas mais comuns são dor, náusea, vômito e hemorragia. A presente casuística consiste de 11 neoplasias malignas e sete benignas. Entre as primeiras o adenocarcinoma é o mais freqüente, sendo os lipomas os mais comuns dos neoplasmas benignos. Enquanto nestes a exérese local representa a conduta mais adequada, a duodenopancreatectomia cefálica foi a cirurgia de escolha nos tumores malignos da segunda porção duodenal, exibindo bons resultados. As lesões malignas da terceira porção e principalmente da quarta porção do duodeno foram tratadas pela ressecção duodenojejunal, também com resultados satisfatórios.

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“…The 5 year survival rate varies widely according to different series published, but is generally reported to be >40% in case of curative resection 5 . The presence of lymph node metastases is not a bad prognostic factor in most series and is not a contraindication for curative resection 6 .…”

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confidence: 99%