Concurrent Chemoradiotherapy in Resected Extrahepatic Cholangiocarcinoma

Abstract

Purpose Extrahepatic cholangiocarcinoma is a rare malignancy. Despite radical resection, survival remains poor, with high rates of local and distant failure. To clarify the role of radiotherapy with chemotherapy, we performed a retrospective analysis of resected patients who had undergone chemoradiotherapy. Methods and Materials A total of 45 patients (13 with proximal and 32 with distal disease) underwent resection plus radiotherapy (median dose, 50.4 Gy). All but 1 patient received concurrent fluoropyrimidine-based chemotherapy. The median follow-up was 30 months for all patients and 40 months for survivors. Results Of the 45 patients, 33 underwent adjuvant radiotherapy, and 12 were treated neoadjuvantly. The 5-year actuarial overall survival, disease-free survival, metastasis-free survival, and locoregional control rates were 33%, 37%, 42%, and 78%, respectively. The median survival was 34 months. No patient died perioperatively. Patient age ≤60 years and perineural involvement adversely affected survival on univariate analysis. Patients undergoing R0 resection had a significantly improved rate of local control but no survival advantage. Despite having more advanced disease at presentation, patients treated neoadjuvantly had a longer survival (5-year survival 53% vs. 23%, p = 0.16) and similar rates of Grade 2–3 surgical morbidity (16% vs. 33%, p = 0.24) compared with those treated in the postoperative setting. Conclusion These study results suggest a possible local control benefit from chemoradiotherapy combined with surgery in patients with advanced, resected biliary cancer. Furthermore, our results suggest that a treatment strategy that includes preoperative chemoradiotherapy might result in improved tumor resectability with similar surgical morbidity compared with patients treated postoperatively, as well as potentially improved survival outcomes. Distant failure remains a significant failure pattern, suggesting the need for more effective systemic therapy.

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

“…Longer survival was seen in patients who received adjuvant therapy (median survival 41 mo vs 24 mo) [243] . Other retrospective studies demonstrated similar results and showed that patients with distal ECC had a superior survival advantage in comparison to more proximal CC following adjuvant therapy [243,244] . Recently, Hughes et al [245] have confirmed a slight 5-year survival advantage with postoperative chemoradiation therapy in patients with distal ECC compared with surgical resection alone (35% vs 27%).…”

WITHDRAWN: Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gallbladder Cancer

“…Median survival was improved with CRT compared with the observation cohort, 37 vs 22 months (P o 0.05). Additionally, Nelson et al 42 demonstrated very high median survival of 34 months for patients treated with CRT before or after resection.…”

Surgical strategy for bile duct cancer: Advances and current limitations

“…Adjuvant chemoradiation has a survival benefit over adjuvant chemotherapy, adjuvant radiation, and surgery alone, especially in distal bile duct cancer [198][199][200][201] . Recently, three retrospective studies emphasized a comparable outcome of adjuvant chemoradiation for patients with non-curative surgery when compared to patients with curative surgery alone [202][203][204] .…”