The effectiveness of various treatments for pancreas cancers The overall survival rate improved by about 25 percent with this treatment in comparison with the observation alone for periampullary adenocarcinoma once adjustments were made for the independent prognostic factors, i.e. p= 0.03. However, this advantage was only generated through a hypothesis as reported by the group of researchers.

As the main trial endpoint, unadjusted different of median survival for 43.1 months with the adjuvant chemo vs. 32 months for the observation alone after the resection failed to reach a significance. The hazard ratio was o.86, 95 percent confidence interval of between 0.66 and 1.11.

Chemo improves survival for periampullary cancer patients

Even though the research findings showed that using adjuvant chemo helps in improving survival for patients of periampullary cancers, there was just a modest effect which indicated that there was need for extra improvements and warranted the testing of a combination of different chemotherapies as concluded by the researchers.

The European Study Group trial for Pancreatic Cancer involved 434 patients from Australia, Europe, Canada and Japan randomized to the open label chemo with Adrucil- fluorouracil and folinic acid or with Gemzar or gemcitabine or observation alone after the resection of periampullary cancer.

The survival wasn’t significantly better for any of the chemo group when compared with observation in unadjusted analysis. The medians were as follows:

  • 35.2 months with the observation
  • 38.9 months survival with adrucil
  •  45.7 months with the gemcitabine

Still, even though the secondary analyses was adjusted for bile duct cancer, age, positive lymph nodes and poor tumor differentiation still put the two chemo groups well ahead when it came to overall survival. The hazard ratios in comparison to observation were as follows:

  • 0.75 with the adrucil
  • 0.70 with gemcitabine

Chemo was still rated ahead when it came to disease free survival. The majority of 428 cancers that were included in primary analysis were in ampulla whereby their bile ducts meet with pancreatic duct, i.e. 297. However, there were still some 96 cases recorded of the bile duct cancer as well as 35 cases of cancer in nearby locations. It was reasonable to lump together the tumor types since their clinical presentation was similar and had an identical treatment via surgery and also had similar molecular and tissue profiles as the researchers noted.

The outcomes of the periampullary cancers

The outcomes had some differences among these kinds of periampullary cancers. The median survival was longest among ampullary cancer patients, especially with the adjuvant cytotoxic treatment standing at 57.8 months with adrucil and 70.8 months after treatment with gemcitabine and observation after surgery was at 40.6 months. Other two groups showed no advantage when chemo therapy was used as the treatment. In conclusion, the researchers noted that there was need to avoid grouping both with the ampullary cancer and with proximal types of bile duct cancers.