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Neoadjuvant Therapy for Duodenal and Ampullary Adenocarcinoma: A Systematic Review
Chunmeng Zhang1, Jason M Lizalek1, Collin Dougherty1
1Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Background:
The role of systemic therapy in the management of ampullary (AA) and duodenal adenocarcinoma (DA) remains poorly understood. This study sought to synthesize current evidence supporting the use of neoadjuvant therapy (NAT) in AA and DA.
Methods:
The study searched PubMed, Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCO), and ClinicalTrials.gov databases for observational or randomized studies published between 2002 and 2022 evaluating survival outcomes for patients with non-metastatic AA or DA who received systemic therapy and surgical resection. The data extracted included overall survival, progression-free survival, and pathologic response (PR) rate.
Results:
From the 347 abstracts identified in this study, 29 reports were reviewed in full, and 15 were included in the final review. The selected studies published from 2007 to 2022 were retrospective. Eight were single-center studies; five used the National Cancer Database (NCDB); and two were European multicenter/national studies. Overall, no studies identified survival differences between NAT and upfront surgery (with or without adjuvant therapy). Two NCDB studies reported longer survival with NAT/AT than with surgery. Five single-center studies reported a significant portion of NAT patients who achieved PR, and one study identified major PR as an independent predictor of survival. Other outcomes associated with NAT included conversion from unresectable to resectable disease, reduced lymph node positivity, and decreased local recurrence rate.
Conclusion:
Evidence supporting the use of NAT in AA and DA is weak. No randomized studies exist, and observational data show mixed results. For patients with DA and AA, NAT appears safe, but better evidence is needed to understand the preferred multidisciplinary management of DA and AA periampullary malignancies.
Insights
Neoadjuvant therapy (NAT) for ampullary (AA) and duodenal adenocarcinoma (DA) shows potential safety and benefits like tumor downstaging. However, current evidence is weak, with no randomized trials and mixed results, necessitating further research for optimal management.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Medical Oncology
Background:
- The role of systemic therapy in ampullary (AA) and duodenal adenocarcinoma (DA) management is unclear.
- This study synthesizes evidence on neoadjuvant therapy (NAT) for AA and DA.
Approach:
- Searched multiple databases (PubMed, Cochrane, Embase, CINAHL, ClinicalTrials.gov) for studies (2002-2022).
- Included observational and randomized studies on non-metastatic AA/DA treated with NAT and surgery.
- Extracted data on overall survival, progression-free survival, and pathologic response (PR).
Key Points:
- 15 retrospective studies (2007-2022) were included; no randomized trials.
- No significant survival differences were found between NAT and upfront surgery.
- NAT showed potential benefits: pathologic response, conversion to resectable disease, reduced lymph node positivity, and decreased local recurrence.
Conclusions:
- Evidence supporting NAT in AA and DA is currently weak.
- Observational data yield mixed results, and no randomized studies exist.
- While NAT appears safe, more robust evidence is needed for optimal periampullary malignancy management.
