Small bowel adenocarcinoma ‑ terra incognita: A demand for cross‑national pooling of data

Schwameis,Katrin; Schoppmann,Sebastian Friedrich; Stift,Judith; Schwameis,Michael; Stift,Anton

doi:10.3892/ol.2014.1919

Small bowel adenocarcinoma ‑ terra incognita: A demand for cross‑national pooling of data

Authors:
- Katrin Schwameis
- Sebastian Friedrich Schoppmann
- Judith Stift
- Michael Schwameis
- Anton Stift
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Affiliations: Gastroesophageal Tumor Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna A‑1090, Austria, Department of Pathology, Medical University of Vienna, Vienna A‑1090, Austria, Department of Clinical Pharmacology, Medical University of Vienna, Vienna A‑1090, Austria, Department of Surgery, Medical University of Vienna, Vienna A‑1090, Austria
Published online on: February 27, 2014 https://doi.org/10.3892/ol.2014.1919
Pages: 1613-1617

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Abstract

To date, due to the rarity, tumor biology and carcinogenesis of small bowel adenocarcinoma (SBA), the disease has been explored insufficiently and immunophenotyping and molecular characterization have not been finalized. This knowledge gap consecutively leads to an overt lack of diagnostic and therapeutic recommendations. In the current study, we provide our experience with the treatment of SBA, and demand for cross‑national data pooling to enable unlimited information transfer and higher powered study. A comprehensive database of all patients with SBA was established and consecutively reviewed for clinicopathohistological data, information concerning preoperative evaluation, surgical and chemotherapeutical treatment, as well as outcome parameters. Patients underwent curative intended surgery (42.4%; n=14), adjuvant chemotherapy (CTX) following resection (36.4%; n=12) or palliative care (21.2%; n=7). The majority of patients were diagnosed at an advanced disease stage (pT3, 36.4%; pT4, 39.4%) and the duodenum was the most common tumor site (57.1%; n=20). Complete surgical resection was achieved in 88.5% of patients, while postoperative complications occurred in 19.4%. Within a mean follow‑up period of 31.4 months, 17 patients succumbed to the disease following a median survival time of 11 months. Mean overall survival (OS) was 47.4, 25.3 and 9.8 months for surgically, surgically and chemotherapeutically and palliatively treated patients, respectively. Early surgical resection remains the mainstay in the treatment of localized SBA, since it is associated with a prolongation of OS. The role of neoadjuvant and adjuvant CTX has not yet been defined. Thus, since no consensus exists on the adequate treatment of these malignancies, we demand an international collaboration and cross‑national data pooling to pave the way for the implementation of evidence‑based standard care operating procedures.

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1	Poddar N, Raza S, Sharma B, Liu M, Gohari A and Kalavar M: Small bowel adenocarcinoma presenting with refractory iron deficiency anemia - case report and review of literature. Case Rep Oncol. 4:458–463. 2011. View Article : Google Scholar
2	Lu Y, Fröbom R and Lagergren J: Incidence patterns of small bowel cancer in a population-based study in Sweden: increase in duodenal adenocarcinoma. Cancer Epidemiol. 36:e158–e163. 2012. View Article : Google Scholar
3	Chang HK, Yu E, Kim J, et al: Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases. Hum Pathol. 41:1087–1096. 2010. View Article : Google Scholar
4	Pan SY and Morrison H: Epidemiology of cancer of the small intestine. World J Gastrointest Oncol. 3:33–42. 2011.PubMed/NCBI
5	Overman MJ: Recent advances in the management of adenocarcinoma of the small intestine. Gastrointest Cancer Res. 3:90–96. 2009.PubMed/NCBI
6	Koo DH, Yun SC, Hong YS, et al: Adjuvant chemotherapy for small bowel adenocarcinoma after curative surgery. Oncology. 80:208–213. 2011. View Article : Google Scholar : PubMed/NCBI
7	Cao J, Zuo Y, Lv F, Chen Z and Li J: Primary small intestinal malignant tumors: survival analysis of 48 postoperative patients. J Clin Gastroenterol. 42:167–173. 2008. View Article : Google Scholar
8	Halfdanarson TR, McWilliams RR, Donohue JH and Quevedo JF: A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg. 199:797–803. 2010. View Article : Google Scholar
9	Overman MJ, Kopetz S, Lin E, Abbruzzese JL and Wolff RA: Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine. Acta Oncol. 49:474–479. 2010. View Article : Google Scholar : PubMed/NCBI
10	Dabaja BS, Suki D, Pro B, Bonnen M and Ajani J: Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer. 101:518–526. 2004. View Article : Google Scholar
11	Edge SB and Compton CC: The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 17:1471–1474. 2010. View Article : Google Scholar : PubMed/NCBI
12	Hong SH, Koh YH, Rho SY, et al: Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome. Jpn J Clin Oncol. 39:54–61. 2009. View Article : Google Scholar
13	Kelsey CR, Nelson JW, Willett CG, et al: Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. Int J Radiat Oncol Biol Phys. 69:1436–1441. 2007. View Article : Google Scholar : PubMed/NCBI
14	Bakaeen FG, Murr MM, Sarr MG, et al: What prognostic factors are important in duodenal adenocarcinoma? Arch Surg. 135:635–641; discussion 641–632. 2000. View Article : Google Scholar
15	Poultsides GA, Huang LC, Cameron JL, et al: Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann Surg Oncol. 19:1928–1935. 2012. View Article : Google Scholar
16	Sasaki Y, Natsuizaka M, Takano M, et al: A case of primary adenocarcinoma of small intestine with multiple liver metastases successfully treated with mFOLFOX6. Gan To Kagaku Ryoho. 36:1927–1929. 2009.(In Japanese).
17	Yamano T, Morii E, Arai I, Takada T and Aozasa K: Successful treatment of recurrent small bowel adenocarcinoma by cytoreductive surgery and chemotherapy: a case report and review of the literature. J Med Case Rep. 4:2132010. View Article : Google Scholar
18	Tsushima T, Taguri M, Honma Y, et al: Multicenter retrospective study of 132 patients with unresectable small bowel adenocarcinoma treated with chemotherapy. Oncologist. 17:1163–1170. 2012. View Article : Google Scholar
19	Xiang XJ, Liu YW, Zhang L, et al: A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma. Anticancer Drugs. 23:561–566. 2012. View Article : Google Scholar : PubMed/NCBI
20	Zhang L, Wang LY, Deng YM, et al: Efficacy of the FOLFOX/CAPOX regimen for advanced small bowel adenocarcinoma: a three-center study from China. J BUON. 16:689–696. 2011.
21	Zaanan A, Gauthier M, Malka D, et al: Second-line chemotherapy with fluorouracil, leucovorin, and irinotecan (FOLFIRI regimen) in patients with advanced small bowel adenocarcinoma after failure of first-line platinum-based chemotherapy: a multicenter AGEO study. Cancer. 117:1422–1428. 2011. View Article : Google Scholar
22	Tsang H, Yau T, Khong PL and Epstein RJ: Bevacizumab-based therapy for advanced small bowel adenocarcinoma. Gut. 57:1631–1632. 2008. View Article : Google Scholar : PubMed/NCBI
23	De Dosso S, Molinari F, Martin V, Frattini M and Saletti P: Molecular characterisation and cetuximab-based treatment in a patient with refractory small bowel adenocarcinoma. Gut. 59:1587–1588. 2010.PubMed/NCBI