Adenocarcinoma of the small bowel at a single Korean institute: management and prognosticators

• Published in: Journal of cancer research and clinical oncology Vol. 136; no. 3; pp. 387 - 394
• Main Authors: Moon, Yong Wha, Rha, Sun Young, Shin, Sang Joon, Chang, Hyun, Shim, Hyo Sup, Roh, Jae Kyung
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.03.2010; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Algorithms; Antineoplastic agents; Biological and medical sciences; Cancer; Cancer Research; Cancer therapies; Chemotherapy, Adjuvant - methods; Chemotherapy, Adjuvant - utilization; Digestive System Surgical Procedures - methods; Female; Gastrointestinal diseases; Hematology; Humans; Internal Medicine; Intestinal Neoplasms - diagnosis; Intestinal Neoplasms - mortality; Intestinal Neoplasms - pathology; Intestinal Neoplasms - therapy; Intestine, Small - pathology; Korea; Male; Medical prognosis; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Paper; Pharmacology. Drug treatments; Prognosis; Recurrence; Retrospective Studies; Treatment Outcome; Young Adult; Asia; Korea; South Korea; Treatment pattern; Small bowel adenocarcinoma; Prognosis; Adenocarcinoma; Clinical management; Treatment; Digestive system; Malignant tumor; Management; Small intestine; Cancer
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-009-0668-3

Purpose Small bowel adenocarcinoma (SBA) is a rare malignancy with a poor outcome. We evaluated the natural history of SBA at a single Korean institute. Methods Medical records of 100 patients with SBA were reviewed for clinical characteristics, treatment patterns, outcomes, and prognostic factors. Results The most common primary tumor site was the duodenum (82%). Seventy-four patients were diagnosed with stage III/IV disease (28/46 patients, respectively). Sixty-six patients had surgery (R0/R1/R2 in 32/2/32) without operation-related mortality. Of 34 R0/R1-resected patients, 16 received adjuvant chemotherapy. The dominant pattern of recurrence following R0/R1 resection was distant metastasis (29%; 10 of 34 patients). Thirty-four patients with advanced SBA received palliative chemotherapy, showing a response rate of 27.6% and a median progression-free survival of 3.8 months. The median overall survival for all patients and R0/R1-resected patients was 10.5 and 42.1 months, respectively. In multivariate analysis, lower stage, nonduodenal location, and R0/R1 resection were good independent prognostic factors. Conclusions Early diagnosis is crucial to improve outcomes of SBA with respect to increasing resectability. Distant metastasis as a dominant pattern of recurrence suggests a potential role for adjuvant chemotherapy. Newer antitumor agents in advanced SBA should be evaluated considering the poor efficacy of current palliative chemotherapy.