Carcinoma of periampullary region; histopathological study and correlation with prognosis

Periampullary malignancies are aggressive neoplasms with low survival rates. The factors favoring long-term survival for periampullary neoplasm are related to histopathologic features, site, stage, resection margins and lymph node metastases. To study some clinical and histopathological parameters of cancer head of pancreas and periampullary region. Statistical study of the impact of these parameters on the outcome of malignancy in this region. This study was carried out on 144 cases of penampullary cancers. The clinical data including, pathological data are revised. Special stains and immunohistochemistry are used when necessary. The most common malignant tumor of peniampullary region is carcinoma of ampulla of vater, then cancer head pancreas, then bile duct carcinoma and lastly duodenal carcinoma [43.7%, 40%, 10% and 6.3% respectively]. We found that the median survival of periampullary cancer is 15 months. The prognosis of these malignant tumors is related to site [P=0.0054], size of the tumor [P=0.0005], grade [P=0.0000], lymph node metastasis [P=0.0123] and tumor stage [P=0.0084]. Other parameters including age and sex, local extension and cut margins are statistically of no significant effects on the prognosis. Periampullary carcinomas are aggressive neoplasm with short survival. It seems that our locality shows epidemiologic factors that leads to that the age of patients at time of presentation and prognosis differ from literatures

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation. 5-fluorouracil and oxallplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006. 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a four-field technique to a dose of 50.4 Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130 mg/m[2] on day 1 plus 30 minute infusion of 100 mg/m[2] L-folinic acid and continuous infusion of fluorouracil. 350 mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [6 7.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%]. the operative specimen was sterilized and in 2/44 patients [4.5%]. only very few residual malignant cells difficult to find microscopically were detected. Pathological down staging was diagnosed in 70.5% [31 out of 44 patients]. Local and distant progression occurred later in 9 patients and the 2- year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were .12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. - Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological down staging and sphincter saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen