A retrospective review of chemotherapy for patients with small bowel adenocarcinoma in British Columbia.

Abstract

Background: Small bowel adenocarcinoma (SBA) is associated with a poor prognosis. It is an uncommon malignancy and therefore difficult to study. Randomized phase III trials are not available to guide best approaches. The Provincial Cancer Registry of the British Columbia Cancer Agency contains long-term data on patients with SBA. The authors analyzed characteristics and treatment outcomes for SBA patients diagnosed between 1990 and 2008. Material and methods: Charts of 150 patients with a histological diagnosis of SBA were retrospectively analyzed. Epidemiological and treatment data were collected. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Results: Baseline characteristics, such as median age at diagnosis (64.5 years), tumor stage (I-II 33%, III-IV 58%, unknown 9%), and location (duodenum 48%, jejunum 31%, ileum 21%) were consistent with published data. 55% of patients had a positive family history of cancer. DFS and OS of 29 patients treated with adjuvant chemotherapy were not significantly different to that of 47 patients without (p = 1 and p = 0.211, respectively). In the palliative setting patients treated with polychemotherapy (21 patients) had statistically better OS than patients treated with monochemotherapy (12 patients) (p = 0.0228). Conclusions: Our study suggests a survival benefit for advanced-stage SBA patients treated with poly-versus monochemotherapy. This, however, was a retrospective analysis with several potential confounders. Nevertheless, our study adds to the evidence suggesting that chemotherapy may be beneficial for patients with SBA, at least in the palliative setting.

Enterovesical fistula caused by ileal primary adenocarcinoma

“…There is a need for high-level evidence studies to better clarify the role of adjuvant chemotherapy in the context of small bowel adenocarcinoma. 18 For jejunal and ileal tumors, curative surgery (R0) consists of a wide resection with free cancer margins, associated with regional lymphadenectomy, similar to colonic adenocarcinomas. 6 Video-laparoscopy and its application in cancer surgery has been gaining greater acceptance among surgeons and consolidating as an effective and safe approach for the surgical treatment of malignant tumors of the small intestine.…”

Palliative chemotherapy for patients with synchronous metastases of small‐bowel adenocarcinoma: A reflection of daily practice

“…Due to the rarity of the disease, most data on palliative chemotherapy in SBA are derived from phase II trials and retrospective series of mainly high‐volume or tertiary medical centres 5–7 . These studies have demonstrated that chemotherapy prolongs overall survival in patients with metastatic SBA 4–15 . However, in the absence of randomised controlled trials, a standard chemotherapeutical regimen has not been defined.…”

“…[5][6][7] These studies have demonstrated that chemotherapy prolongs overall survival in patients with metastatic SBA. [4][5][6][7][8][9][10][11][12][13][14][15] However, in the absence of randomised controlled trials, a standard chemotherapeutical regimen has not been defined. Patients are usually treated with chemotherapeutical regimens which have been extrapolated from other gastrointestinal cancers.…”