Evolution of Treatment of Cancer of the Major Duodenal Papilla

Abstract

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.