Patterns of failure after resection of extrahepatic bile duct cancer: implications for adjuvant radiotherapy indication and treatment volumes

Abstract

BackgroundThe role of adjuvant radiotherapy (RT) and setting proper RT target volumes have not been clearly demonstrated for extrahepatic bile duct (EHBD) cancer, due to the rarity of the disease and the lack of randomized trials. This study was conducted to evaluate the indication and treatment volume for adjuvant RT in EHBD cancer patients by identifying the prognostic factors for loco-regional (LR) failure, and analyze the patterns of LR failure.MethodsNinety-three patients with EHBD cancer, who underwent resection without adjuvant RT, at 2 medical centers, between 2001 and 2016, were analyzed retrospectively. Univariable and multivariable analyses were performed to find the prognostic factors for LR recurrence. The initial patterns of failure were recorded, especially those of LR recurrence, and categorized according to the Japanese classification.ResultsThe median follow-up duration was 30 months, and 38 (40.9%) patients experienced LR recurrence during this period. With regards to LR recurrence, close or positive resection margin (RM) status (p < 0.001) remained statistically significant in the multivariable analysis. The most common LR recurrence sites were the tumor bed (18.3%), and lymph node (LN) stations No. 8 (14.1%), No. 9 (12.7%), No. 12 (12.7%), No. 13 (5.6%), No. 14 (21.1%), No. 16 (14.1%), and No. 17 (1.4%).ConclusionsA close or positive RM status may be suggestive of high LR recurrence rates. In such cases, adjuvant RT may improve outcomes. When adjuvant RT is performed, the treatment volume should be well-designed so as to encompass the tumor bed, as well as LN stations No. 8, No. 9, No. 12, No. 14, and No. 16.Electronic supplementary materialThe online version of this article (10.1186/s13014-018-1024-z) contains supplementary material, which is available to authorized users.

Radiation therapy for extrahepatic bile duct cancer: Current evidences and future perspectives

“…The authors also noted the resection margin (RM), hilum, and bilioenteric anastomosis as sites of local recurrence. The LRF sites were concordant with those found in the aforementioned studies[10,11].…”

“…Locoregional failure (LRF) has been reported as the most common type of initial EBDC treatment failure. Two Korean studies[10,11] reported the patterns of initial treatment failure among EBDC patients who underwent curative resection. Choi et al[10] analyzed the patterns of failure among 93 EBDC patients who underwent gross total resection and no adjuvant RT.…”

“…Two Korean studies[10,11] reported the patterns of initial treatment failure among EBDC patients who underwent curative resection. Choi et al[10] analyzed the patterns of failure among 93 EBDC patients who underwent gross total resection and no adjuvant RT. Tumor recurrence occurred in 54 patients: isolated LRF in 18 (19%), both LRF and distant metastasis (DM) in 20 (22%), and DM alone in 16 (17%).…”

Stereotactic Body Radiation Therapy for Cholangiocarcinoma: Optimizing Locoregional Control With Elective Nodal Irradiation

“…17e20 Gil et al 19 found tumor size 4 cm and lymph node metastases as the most significant predictors of recurrence and survival among 153 patients treated with primary surgery for cholangiocarcinoma. The authors proposed adjuvant RT fields cover the resection bed and the perihilar, periduodenal, peripancreatic, celiac, caval, and para-aortic 20 recently mapped sites of regional lymph node metastases in 93 patients with extrahepatic biliary carcinoma treated with surgical resection. A total of 38 patients experienced regional lymph node failure, most commonly at the celiac, superior mesenteric, para-aortic, and common hepatic locations.…”

Radiation Therapy for Cholangiocarcinoma

“…approximating 40 to 50% in many series. [4][5][6] The addition of adjuvant therapy, including chemotherapy and radiation, has been investigated to improve upon these rates. Due to proximity of the duodenum and sensitive small bowel in extrahepatic CC, adjuvant radiation must be delivered in a fractionated course over 5 to 6 weeks.…”