Would you recommend adjuvant chemoradiation for a resected ampullary adenocarcinoma?

There is no clear cut answer to this question. There is suggestive evidence from retrospective studies that adding radiation therapy to a chemotherapy regimen improves outcomes, but those are retrospective and non-randomized, with all the inherent difficulties in those analyses. The limited randomized data do not show an advantage to the use of RT and they more clearly show a role for adjuvant chemotherapy.

For early stage ampullary carcinoma I would not use RT at all. However, for node positive or margin positive (or very close) disease I would consider using RT after 3-6 months of chemotherapy. However, I would be very clear to the patient that this is a soft call. There is obviously logic behind this approach in that the presence of nod...