Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline

Shroff, Rachna T.; Kennedy, Erin B.; Bachini, Melinda; Bekaii‐Saab, Tanios; Crane, Christopher H.; Edeline, Julien; El-Khoueiry, Anthony B.; Feng, Mary; Katz, Matthew H.; Primrose, John; Soares, Heloisa P.; Valle, Juan W.; Maithel, Shishir K.

doi:10.1200/jco.18.02178

Cited by 337 publications

(260 citation statements)

References 39 publications

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“…Various AT strategies have been used in ICC patients following radical resection to improve their prognosis; however, the benefit of AT has always been questioned . In this study, we collected multicenter ICC patient data, including 77 patients who received AT after a radical resection, and the results showed that these patients had a longer median OS and DFS than who did not receive AT.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

et al. 2020

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Background and Aims: The prognosis of intrahepatic cholangiocarcinoma (ICC) after radical resection is far from satisfactory; however, the clinical value of adjuvant therapy (AT) remains controversial. This multicenter study aimed to evaluate the clinical value of AT and identify potential patients who would be benefited from AT. Methods: Data from ICC patients who underwent radical resection were retrospectively collected from 12 hepatobiliary centers in China between December 2012 and December 2015. Patients were divided into AT and non-AT groups based on whether AT was administered or not. Overall survival (OS) and disease-free survival (DFS)were analyzed using the Kaplan-Meier method before and after 1:2 propensity score matching (PSM). Subgroup analyses were conducted based on the established staging systems. | 2675WANG et Al.

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Section: Discussionmentioning

confidence: 99%

“…The incidence of ICC patients receiving adjuvant chemotherapy is reported to be as high as 46.6%, although cholangiocarcinoma is less sensitive to chemotherapeutics than other cancers . Fluoropyrimidine‐ and gemcitabine‐based chemotherapy regimens are widely used and were confirmed to prolong OS in recent meta‐analyses .…”

Section: Discussionmentioning

confidence: 99%

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

et al. 2020

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“…14 From the American Society of Clinical Oncology (ASCO) Clinical Practice Guidelines, patients who have been treated with resection should receive adjuvant capecitabine chemotherapy for 6 months and a microscopically positive surgical margin resection (R1) may be offered adjuvant chemoradiotherapy. 64 The regimens of chemoradiotherapy were based on the SWOG trial. In the absence of data from randomized trials, prospective clinical trials participation should be encouraged.…”

Section: Guidelines and Future Directionmentioning

confidence: 99%

<p>The Significance of Adjuvant Therapy for Extrahepatic Cholangiocarcinoma After Surgery</p>

Wang

Xia

et al. 2019

CMAR

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Extrahepatic cholangiocarcinoma (EHCC) is a rare malignant tumor, and current treatment methods are also relatively limited. Radical surgery is the only potentially curative method for the long survival time. However, despite undergoing radical resection, prognosis remained poor due to the high recurrence rate and distant metastasis. Therefore, adjuvant chemotherapy and radiotherapy should be offered to patients who have undergone surgery. Unfortunately, the low incidence of this disease has resulted in a lack of high-level evidence to confirm the importance of adjuvant chemotherapy or radiotherapy. At present, it is still controversial whether adjuvant therapy can prolong the survival of patients after operation, especially patients with negative margins or lymph nodes. Furthermore, standard regimens of adjuvant have not been identified. This review summarizes the currently available evidence of the effect of adjuvant therapy in the management of EHCC. Ultimately, we concluded that adjuvant therapy may improve survival in high-risk (positive margin or lymph node or advanced stage) patients and adjuvant concurrent chemoradiotherapy followed by chemotherapy may be the optimum selection for them. This needs to be verified by randomized prospective clinical trials.

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“…Acceptable toxicity and promising efficacy of the modern chemoradiotherapy (CRT) demonstrated in a prospective Phase II trial, and results of the meta‐analysis supporting adjuvant treatment for BTC have led to the growing use of this adjuvant approach, especially in patients with an R1 resection or positive lymph nodes . According to the latest ASCO guidelines for adjuvant therapy for resected BTC, an R1 resection status is the indication for postoperative CRT in EHC and gallbladder cancer (GBC) . However, only limited data are still available to guide the clinical target volume (CTV) delineation in BTC, especially with respect to the subsite of disease and the T‐stage of the tumour .…”

Section: Introductionmentioning

confidence: 99%

“…1,4 According to the latest ASCO guidelines for adjuvant therapy for resected BTC, an R1 resection status is the indication for postoperative CRT in EHC and gallbladder cancer (GBC). 5 However, only limited data are still available to guide the clinical target volume (CTV) delineation in BTC, especially with respect to the subsite of disease and the Tstage of the tumour. [6][7][8][9] The most common pattern of locoregional recurrence in BTC is nodal.…”

Section: Introductionmentioning

confidence: 99%

Nodal CTV selection according to primary tumour location and pT stage for biliary tract cancer

2019

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Introduction/Purpose To assist radiation oncologists in determining the elective nodal CTV for biliary tract cancer, we aimed to provide the rules for selection of the CTV for each subsite of biliary tract with respect to the pT stage, based on the analysis of the incidence and location of metastatic lymph nodes. Methods Systematic review and meta‐analysis was performed to determine the rate of pathological nodal involvement of each individual lymph node station (LNS) as a function of the primary tumour pT stage (pT1‐2 vs. pT3‐4) separately for right intrahepatic cholangiocarcinoma (rIHC), left/hilar intrahepatic cholangiocarcinoma l/hIHC), proximal extrahepatic cholangiocarcinoma (pEHC), middle extrahepatic cholangiocarcinoma (mEHC), distal extrahepatic cholangiocarcinoma (dEHC) and gall bladder cancer (GBC). A 5% or higher risk of involvement was assumed to justify inclusion of the LNS in the CTV. Results Coeliac LNS, which is usually included in the CTV in clinical practice, has a low risk of involvement and can presumably be omitted for pT1‐2 GBC, for dEHC irrespective of pT stage and for mEHC. Para‐aortic and superior mesenteric artery (SMA) LNS that are usually omitted have a high risk of involvement. Para‐aortic LNS should be considered for inclusion for all the subsites except for pT1‐2 dEHC, and SMA LNS for all the subsites except for pT1‐2 dEHC, pT1‐2 GBC and pEHC. Left gastric artery, lesser curvature and paracardial LNS should be considered for inclusion for l/hIHC. Conclusion This systematic review provides an evidence‐based strategy for nodal CTV selection in biliary tract cancer according to primary tumour location and pT stage.

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Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline

Cited by 337 publications

References 39 publications

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

<p>The Significance of Adjuvant Therapy for Extrahepatic Cholangiocarcinoma After Surgery</p>

Nodal CTV selection according to primary tumour location and pT stage for biliary tract cancer

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