Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer

Kim, Su Zy; Kim, Sun Whe; Bang, Yong Joo; Heo, Dae Seog; Ha, Sung Whan

doi:10.1016/s0360-3016(02)02952-8

Cited by 103 publications

(83 citation statements)

References 21 publications

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“…However, the success rate of obtaining secondary R0 resection is limited because of procedural difficulties. [9][10][11][12][13][14][15] Moreover, another author noted that additional resection of positive proximal bile duct RM in hilar cholangiocarcinoma did not improve OS, suggesting that further studies are indispensable to evaluate the role of additional resection of positive RM. 7 Several studies investigated the benefit of adjuvant RT to countervail the adverse effect of positive RM.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] However, obtaining a negative resection margin (RM) is a challenge, 7,8 and microscopic (R1) and macroscopic (R2) residual diseases are observed in 20-40% and 4-64%, respectively. [9][10][11][12][13][14][15] Many studies have revealed that positive RM of EHBD cancer is directly associated with high local recurrence (LR) rate. 9,11,15,16 As a result, LR is a major pattern of failure in EHBD cancer.…”

Section: Introductionmentioning

confidence: 99%

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Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Kim

Min

et al. 2017

The British Journal of Radiology

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Objective: To evaluate the benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic bile duct (EHBD) cancer. Methods: From 1997 to 2015, 59 patients with EHBD cancer were the subject of this study; 36 patients not undergoing adjuvant treatment after surgery (observation group) and 23 patients receiving adjuvant RT (RT group) were compared. Microscopic residual disease (R1) was in 9 (25%) patients and 5 (22%) patients, and macroscopic residual disease (R2) was in 2 (6%) patients and 6 (26%) patients in the observation and RT groups, respectively. Adjuvant RT was delivered to the tumour bed and regional lymph nodes up to 50.4 Gy (range, 45-61 Gy). Results: With a median follow-up of 19 months, local recurrence was observed in 10 (28%) patients and 2 (9%) patients in the observation and RT groups, respectively. On univariate analysis, the 5-year local recurrence-free survival (LRFS) rates were 50% in the observation group and 54% in the RT group (p 5 0.401).The 5-year overall survival (OS) rates were 29.3% in the observation group and 26.3% in the RT group (p 5 0.602). On multivariable analysis, however, adjuvant RT significantly improved LRFS [hazard ratio (HR), 0.310; 95% confidence interval (CI), 0.100-0.963; p 5 0.043] and had a trend towards increased OS (HR, 0.491; 95% CI, 0.219-1.102; p 5 0.085). Resection margin (RM) status was also correlated with LRFS (HR for R1 6.134, 95% CI 2. and HR for R2 18.551,; p , 0.001) and OS (HR for R1 1.816, 95% CI 0.853-3.867; and HR for R2 3.564, 95% CI 1.175-10.809; p 5 0.054). Conclusion: RM status was a significant prognosticator of EHBD cancer, and adjuvant RT improved local control rate; thereby, survival rate might be increased. Advances in knowledge: The benefit of adjuvant RT in EHBD cancer was demonstrated via comparison with observation group.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Kim

Min

et al. 2017

The British Journal of Radiology

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“…Previous retrospective data revealed favorable outcomes of adjuvant chemoradiation (Table 3). 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] .…”

Section: Adjuvant Chemoradiation Therapymentioning

confidence: 99%

“…16 mo OS 0.020 Chemotherapy; 5-FU 8 mo MS (Radiation alone) Kim et al [199] 2002 Bile duct cancer 9% 5-yr OS (Radiation alone) 41% 5-yr OS 0.0005 Chemotherapy; 5-FU, P = 0.14 in multivariate analysis Serafini et al [200] 2001 Bile duct cancer 29 mo MS (Surgery alone) 42 mo MS 0.07 Chemotherapy; 5-FU; when stratified by location, only distal tumors significantly benefited (41 mo MS vs 25 mo MS, P < 0.05) Hughes et al [201] 2007 …”

Section: Nsmentioning

confidence: 99%

Surgical strategy for bile duct cancer: Advances and current limitations

Akamatsu

Sugawara²,

Hashimoto³

2011

WJCO

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The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon's ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud's segment Ⅳ coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pyloruspreserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy.

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“…Similarly, two retrospective series of fluoropyrimidine-based post-operative chemoradiation from MD Anderson Cancer Center [39] and from South Korea [40] , including 96 patients affected by ampullary adenocarcinoma and 91 patients with extrahepatic bile duct cancer, respectively, suggested an improved OS only in patients with locally advanced tumor (T3/T4) [39] or with R1 resection [40] . A few other smaller retrospective series also reported a modest potential OS benefit with adjuvant CRT (Table 1) [38,39,[41][42][43][44][45] .…”

Section: Chemoradiationmentioning

confidence: 97%

Adjuvant treatment in biliary tract cancer: To treat or not to treat?

Cereda

Belli

Reni

2012

WJG

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Biliary tract cancer is a rare malignant tumor. There is limited knowledge about biology and natural history of this disease and considerable uncertainty remains regarding its optimal diagnostic and therapeutic management. The role of adjuvant therapy is object of debate and controversy. Although resection is identified as the most effective and the only potentially curative treatment, there is no consensus on the impact of adjuvant chemotherapy and/or radiotherapy on the high incidence of disease recurrence and on survival. This is mainly due to the rarity of this disease and the consequent difficulty in performing randomized trials. The only two prospectively controlled trials concluded that adjuvant chemotherapy did not improve survival. Most of the retrospective trials, which had limited sample size and included heterogeneous patients population and non-standardized therapies, suggested a marginal benefit of chemoradiotherapy in reducing locoregional recurrence and an uncertain impact on survival. Welldesigned multi-institutional randomized trials are necessary to clarify the role of adjuvant therapy. Two ongoing phase Ⅲ trials may provide relevant information.

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Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer

Cited by 103 publications

References 21 publications

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Surgical strategy for bile duct cancer: Advances and current limitations

Adjuvant treatment in biliary tract cancer: To treat or not to treat?

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