What is the role for adjuvant chemotherapy and/or radiation in ampullary carcinoma?

Such a challenging question because of a paucity of good data. When I try to decide what to do in this setting, a lot of it depends upon the patient's clinical factors (ability to tolerate therapy, postoperative recovery, margin status, etc).

Based on ESPAC-3, I felt pretty comfortable that for most patients, some form of chemotherapy was better than none, and the decision about FU-based versus Gem-based I could change based on histology (FU for intestinal type, Gem for pancbiliary type). Howeve...