Simple Summary
Ampullary adenocarcinoma is a rare tumor in the gastrointestinal tract. Surgery is the preferred treatment, however if a patient has other medical conditions or advanced disease, surgery may not be possible. In this situation, the best treatment strategy is unknown. We sought to find out what happens to these patients in terms of treatments and survival. We used the National Cancer Database 2004–2017 to find 2176 patients who were diagnosed with ampullary adenocarcinoma but did not undergo surgery. The majority of these patients did not receive any chemotherapy or radiation. The rest received a combination of chemotherapy, palliative radiation, and/or definitive radiation. One-year overall survival ranged from 35% in patients who only received palliative radiation to 59.4% in patients who received chemotherapy and definitive radiation therapy. We did not find a significant difference in survival between patients who received chemotherapy and those who received chemotherapy and definitive radiation therapy.
Abstract
Surgical resection is the standard of care for ampullary adenocarcinoma (AC). Many patients are ineligible due to comorbidities/advanced disease. Evidence for the optimal non-operative management of localized AC is lacking. We hypothesize that patients treated with chemotherapy (CT) and definitive radiation (DRT) will have superior survival (OS) compared to those treated with CT alone. We performed a retrospective review of the National Cancer Database from 2004 to 2017 to identify patients with non-metastatic AC and no surgical intervention. Patients were categorized as having received no treatment, palliative radiotherapy (PRT) alone, CT alone, CT + PRT, DRT alone, or CT + DRT. We utilized Kaplan–Meier analysis to determine OS and the log-rank test to compare survival curves. Among 2176 patients, treatment groups were: No treatment (71.2%), PRT alone (1.9%), CT alone (13.1%), CT + PRT (1.6%), DRT alone (2.4%), and CT + DRT (9.7%). One-year OS varied by treatment group, ranging from 35.1% (PRT alone) to 59.4% (CT + DRT). The one-year OS in a matched cohort was not significantly different between CT alone and CT + DRT (HR 0.87, 95% CI 0.69–1.10, p = 0.87). Most patients with non-metastatic AC not treated with surgery do not receive any treatment. There is no difference in one-year OS between those undergoing CT alone and CT + DRT.

@dijones, I can understand your wanting to know what to expect as cancer progresses without treatment. This is best answered by your brother's cancer team who know the status of his tumor (stage), overall health status and possible co-conditions.

Do you know what stage of ampullary cancer your brother has? Does he have a palliative care team to keep him comfortable?

I don't know because I chose to do all three. I was diagnosed with ampulla of Vater adenocarcinoma in January of 2023, shortly before my 59th birthday. I did my own research and consulted with a specialist at City of Hope and based on what I was hearing I came to the conclusion that my best chance of long-term survival was to have the Whipple procedure performed as soon as possible. I managed to get the surgery done by the end of February 2023. I pushed for the earliest possible date. I had clean margins but significant lymph node involvement. After consulting with my doctors I decided to follow up immediately with chemo (12 rounds of folfirinox) and afterwards radiation. Chemo was awful, radiation not so bad, relatively. It took a year to complete my follow up therapies. It took a while after that before I started feeing myself again. My digestion will never be the same but it's not that bad, really. I started taking Creon to help with digestion. I was always health conscious and in pretty good shape before this happened so it came as quite the surprise. But I had a couple of situations in life that had me extremely stressed for a long time, which I think led up to the cancer. I made a number of changes to reduce my stress levels and now, both physically, and mentally, I feel fantastic. Follow up scans as recently as last weekend have so far been clear. I don't know if, when, or where the cancer will show up again but I am very happy I went through with the surgery, chemo, and radiation. Don't get me wrong. It totally sucked and I had some really hard times getting through it all. But for me, my wife, and my children it was totally worth it.