Chemotherapy in small bowel adenocarcinoma: 10-year experience of the British Columbia cancer agency

Aims: Small bowel adenocarcinoma (SBA) is a rare, frequently lethal, malignancy. Little is known about the use and value of chemotherapy in patients with SBA. We assessed this issue in a consecutive cohort of patients from British Columbia, Canada. Materials and methods: Consecutive patients with SBA seen at the British Columbia Cancer Agency from January 1990 to September 2000 were identified. A retrospective systematic chart review was undertaken and a survival analysis conducted. Results: Forty-eight SBA were identified in 47 subjects. Chemotherapy was given to 21 of the 47 subjects (45%). Of 19 patients treated initially with curative intent, the median overall survival was 38.6 months. Five received adjuvant chemotherapy, with two subsequently recurring. Thirty-seven patients initially or eventually had advanced disease: 16 received 22 palliative intent fluoropyrimidine-based regimens. Only one partial response was seen in the first line (objective response rate 6%). The median overall survival for those who received palliative chemotherapy was 15.6 months compared with 7.7 months for those who did not. Conclusions: Chemotherapy use is common in SBA. Our data and available published studies suggest that chemotherapy may provide benefit, but the optimal chemotherapy regimen and the degree of benefit remain to be defined. A sound approach to investigate the management of rare malignancies is desperately needed.