PROSPECTS FOR NEOADJUVANT TREATMENT OF AMPULLARY CANCER

Abstract

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.