Duodenal adenocarcinoma: neoadjuvant and adjuvant therapy strategies

ABSTRACT Introduction: Duodenal adenocarcinoma (DA) is a relatively rare gastrointestinal malignancy associated with poor outcomes. The mainstay of treatment is surgical resection with regional lymphadenectomy but recurrence rates remain high. Due to the relatively low incidence of DA, the lack of randomized controlled trials, and its inclusion with heterogeneous groups of periampullary and other small bowel cancers, strong evidence for the use of neoadjuvant or adjuvant treatment approaches is lacking. Areas covered: The purpose of this article is to review the existing literature on neoadjuvant and adjuvant therapy options along with surgical options for patients with DA. Expert opinion: The primary management of localized DA is surgical resection with negative margins and regional lymphadenectomy. Adjuvant therapy should be recommended for all patients with high-risk pathologic features such as positive lymph nodes or microscopically positive margins. The use of neoadjuvant therapy should be reserved for those patients with locally advanced disease who require downstaging to facilitate resectability. Nevertheless, given the relative rarity of DA, the available literature to guide optimal multimodality treatment decisions is minimal and additional research is needed. In the meantime, patients with DA should be treated at experienced tertiary centers by multidisciplinary oncology teams.