Cancer of the major duodenal papilla is a rare disease with a reported population incidence of 6 per million. Endoscopic ultrasonography and intraductal ultrasonography are useful for diagnosing tumor extension of the major duodenal papilla. However, there are no specific biochemical studies or tumor markers, and an algorithm for early diagnosis of cancer of the major duodenal papilla has not been developed. Pancreatoduodenal resection remains the main treatment method for patients with a resectable tumor. However, long-term outcomes of radical surgeries are not satisfactory, with the median survival rate of 52–113 months, and the 5-year survival rate of 30–78.8 %. The study of prognostic factors will allow the development of the effective schemes of radical treatment, a therapeutic algorithm that will inevitably increase life expectancy. Radical surgery should be integrated into multi-modal treatment. Of all the variety of prognostic factors, the morphological differentiation of the tumor is of interest. According to our data, the overall 5-year survival rate, the average life expectancy for pancreatobiliary and intestinal subtypes of cancer of the major duodenal papilla after expanded pancreatoduodenal resection, respectively, was 0 % versus 38.05 % and 9.3 ± 1.79 months versus 48.0 ± 7.69 months. An accurate morphological diagnosis is of paramount prognostic importance, since it can have therapeutic consequences; that is, morphologically oriented and specific (neo)adjuvant treatment corresponding to subtypes of cancer of the major duodenal papilla. Currently, a multi-modal approach in the treatment of cancer of the major duodenal papilla is under development. Data on the use of adjuvant therapy in the radical treatment regimen are contradictory. There are no randomized controlled trials for neoadjuvant treatment. Little attention is paid to complications of chemotherapy and radiation therapy in the neoadjuvant treatment option. According to our data, chemoembolization of the gastro-duodenal artery resulted in complications in 21.4 %, and external beam radiation therapy resulted in radiation-induced injuries in 25 %. NCC N and ESMO currently do not provide recommendations for (neo)adjuvant treatment of cancer of the major duodenal papilla.
Objective: to study the possibilities of preoperative radiation therapy in a radical treatment regimen for glandular ampullary cancer. Materials and methods. In 2001-2019, 21 cases of pancreatic-biliary type of ampullary cancer underwent radical treatment, including preoperative RT, extended GPDR and adjuvant chemotherapy according to indications (experimental group), 48 cases of pancreatic-biliary type of ampullary cancer underwent expanded GPDR and adjuvant chemotherapy according to indications (control group), and 43 cases of intestinal type of ampullary cancer underwent extended GPDR and adjuvant chemotherapy according to indications. Results. Radiation therapy caused radiation injuries in 28.6% of patients: grade 1 erythema (19.1%), grade 1 leukopenia (4.75%), and grade 2 leukopenia (4.75%). Postoperative complications, mortality of the experimental group and the control group, respectively, amounted to 28.6% and 50.0% (p = 0.09) and 4.8% and 6.3% (p = 0.8). The overall 5-year survival rate, the average life expectancy of the experimental group and the control group, respectively, were 50.7% and 9.8% (p = 0.01) and 74.8 ± 12.58 months and 21.7 ± 6.11 months (p = 0.0008). The overall 5-year survival rate, the average life expectancy of the group with intestinal ampullary cancer, were 61.3% and 60.5 ± 9.15 months, respectively. Relapse-free survival of patients with glandular ampullary cancer (n = 112) who received treatment according to the radical regimen was: 1-year - 77.8%, 3-year - 51.0%, 5-year - 35.2%, average life expectancy - 44.7 ± 5.44 months Conclusion. Radiation injuries were stopped by conservative measures and did not increase the duration of the preoperative period. Preoperative RT in the radical treatment regimen for pancreatic-biliary type of ampullary cancer neither changed the nature nor increased the incidence of postoperative complications. Combined treatment significantly improved long-term survival in cases with pancreatic-biliary type of ampullary cancer.
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