Extrahepatic Bile Duct Cancers: Surgery Alone Versus Surgery Plus Postoperative Radiation Therapy

Gwak, Hee Keun; Kim, Woo Chul; Kim, Hun Jung; Park, Jeong Hoon

doi:10.1016/j.ijrobp.2009.07.003

Cited by 48 publications

(57 citation statements)

References 29 publications

(43 reference statements)

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“…7 Several studies investigated the benefit of adjuvant RT to countervail the adverse effect of positive RM. 14,[17][18][19][27][28][29][30] Small retrospective studies demonstrated that there was no significant OS difference between negative RM group without adjuvant RT and positive RM group with adjuvant RT. 14, 18 Gwak et al 17 reported that patients with R1 resection who received adjuvant RT had significantly higher median disease-free survival than those who received R1 resection alone.…”

Section: Discussionmentioning

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%

“…9,11,15,16 As a result, LR is a major pattern of failure in EHBD cancer. 17 In spite of the high LR rate, the utility of adjuvant radiotherapy (RT) for EHBD cancer has been sparse. 2 Administration of adjuvant RT may increase local control rate, and improved local control might result in survival benefit.…”

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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“…[100][101][102][103][104] Patients with resectable ECC who had microscopically positive resection margins showed higher median disease-free survival rates (21 months versus 10 months, P ¼ 0.042) and decreased local failure (35.6% versus 61.7%, P ¼ 0.02) with postoperative adjuvant radiation than with resection alone; these outcomes were doubled compared with no adjuvant therapy in patients with a positive resection margin and lymph node metastasis. 105 In patients with resected ICC and concurrent lymph node metastases, postoperative adjuvant radiotherapy improved the median survival time compared with no radiotherapy (19.1 months versus 9.5 months, P ¼ 0.011). 106 However, in the studies of Stein et al 107 and Oh et al, 108 patients with lymph-node negative hilar CCA or ECC with a positive resection margin benefited from postoperative adjuvant radiotherapy, but not those with lymph node metastases.…”

Section: Radiotherapymentioning

confidence: 90%

A review of the clinical diagnosis and therapy of cholangiocarcinoma

2013

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Cholangiocarcinoma (CCA) is the second most common primary hepatic malignancy worldwide. The incidence of intrahepatic CCA is increasing, whereas that of extrahepatic CCA is decreasing. This review looks at the new advances that have been made in the management of CCA, based on a PubMed and Science Citation Index search of results from randomized controlled trials, reviews, and cohort, prospective and retrospective studies. Aggressive interventional approaches and new histopathological techniques have been developed to make a histological diagnosis in patients with high risk factors or suspected CCA. Resectability of the tumour can now be assessed using multiple radiological imaging studies; the main prognostic factor after surgery is a histologically negative resection margin. Biliary drainage and/or portal vein embolization may be performed before extended radical resection, or liver transplantation may be undertaken in combination with neoadjuvant chemotherapy or chemoradiotherapy. Though many advances have been made in the management of CCA, the standard modality of treatment has not yet been established. This review focuses on the clinical options for different stages of CCA.

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“…Fiveyear overall survival rates were 34% and 14%, respectively (p=0.014). In another study, Gwak et al compared 31 patients receiving adjuvant radiotherapy with 40-54 Gy to 47 patients without radiotherapy (10). In the subgroup of patients who received a R1-resection (20 and 27 patients, respectively), median disease-free survival was significantly better in the radiotherapy group (21 vs. 10 months, p=0.042).…”

Section: Discussionmentioning

confidence: 99%