Abstract
BackgroundThere is currently no standard adjuvant therapy for patients with curatively resected extrahepatic biliary tract cancer (EHBTC). The aim of this study was to analyze the clinical features and outcomes between patients undergoing adjuvant concurrent chemoradiation therapy (CCRT) alone and those undergoing CCRT followed by adjuvant chemotherapy after curative resection.MethodsWe included 120 patients with EHBTC who underwent radical resection and then received adjuvant CCRT with or without further adjuvant chemotherapy between 2000 and 2006 at Seoul National University Hospital.ResultsOut of 120 patients, 30 received CCRT alone, and 90 received CCRT followed by adjuvant chemotherapy. Baseline characteristics were comparable between the two groups. Three-year disease-free survival (DFS) rates for CCRT alone and CCRT followed by adjuvant chemotherapy were 26.6% and 45.2% (p = 0.04), respectively, and 3-year overall survival (OS) rates were 30.8% and 62.6% (p < 0.01), respectively. CCRT followed by adjuvant chemotherapy showed longer survival than did CCRT alone, especially in R1 resection (microscopically positive margins) or negative lymph node.ConclusionAdjuvant CCRT followed by adjuvant chemotherapy prolonged DFS and OS, compared with CCRT alone in patients with curatively resected EHBTC. Adjuvant chemotherapy deserves to consider after adjuvant CCRT. In the future, a randomized prospective study will be needed, with the objective of investigating the role of adjuvant chemotherapy.
Highlights
There is currently no standard adjuvant therapy for patients with curatively resected extrahepatic biliary tract cancer (EHBTC)
Out of 120 patients, 30 received concurrent chemoradiation therapy (CCRT) alone, and 90 received CCRT followed by adjuvant chemotherapy
Our study showed that CCRT followed by adjuvant chemotherapy was more effective than CCRT alone for CA 19-9 levels elevated above the median value
Summary
There is currently no standard adjuvant therapy for patients with curatively resected extrahepatic biliary tract cancer (EHBTC). Several retrospective studies and phase II studies have reported that CCRT might have some benefits for local control, especially in the management of patients with positive microscopic margins and positive lymph nodes [10,11,12].
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