Figure.

Possible therapeutic algorithm for the management of patients with ampullary carcinoma in the adjuvant and palliative setting in first-line therapy. Stage III is defined by confirmation of positive lymph nodes or T4 situation without confirmation of distant metastases (classification of the Union internationale contre le cancer [UICC], 8^th edition).

*At stage III and in the R1 situation, fluorouracil (5-FU) based radiochemotherapy can be discussed.

Therapeutic schemes: CAPOX: capecitabine/oxaliplatin; FOLFOX: folic acid, fluorouracil and oxaliplatin; FOLFIRI: folic acid, fluorouracil, irinotecan;

mFOLFIRINOX: oxaliplatin, leucovorin, irinotecan, fluorouracil; FOLFIRINOX: fluorouracil/leucovorin, irinotecan, and oxaliplatin

Ca, capecitabine; ECOG, Performance Status der Eastern Cooperative Oncology Group; NGS, next generation sequencing; MSI, microsatellite instability