Comparison of the effects of adjuvant concurrent chemoradiotherapy and chemotherapy for resected biliary tract cancer

Hyera Kim,Jin Young Kim,Mi Hwa Heo

doi:10.1186/s12876-020-1171-1

Abstract

BackgroundBiliary tract cancers (BTC) have a poor prognosis even after curative resection because of frequent local and distant recurrences. Therefore, the importance of adjuvant therapy in BTC has been advocated to improve outcomes. However, the choice of adjuvant therapy is still controversial. The aim of this study was to compare the effects of adjuvant concurrent chemoradiotherapy (CCRT) and chemotherapy on resected BTC.MethodsWe analyzed 92 patients who had curatively resected BTC and had received adjuvant CCRT or chemotherapy from January 2000 to December 2017 at Keimyung University Dongsan Medical Center.ResultsOf the patients, 46 received adjuvant CCRT and 46 received adjuvant chemotherapy. The median recurrence-free survival (RFS) for the adjuvant CCRT and chemotherapy groups were 13.8 and 11.2 months (p = 0.014), respectively. The median overall survival (OS) for the adjuvant CCRT and chemotherapy groups were 30.1 and 26.0 months (p = 0.222), respectively. Adjuvant CCRT had significantly better RFS and numerically higher OS than did chemotherapy. For subgroups with no lymph node (LN) involvement (RFS p = 0.006, OS p = 0.420) or negative resection margins (RFS p = 0.042, OS p = 0.098), adjuvant CCRT led to significantly longer RFS and numerically higher OS than did chemotherapy. For multivariate analysis, the pattern of adjuvant treatment (chemotherapy vs. CCRT, p = 0.004, HR 2.351), histologic grade (poor vs. well, p = 0.023, HR 4.793), and LN involvement (p = 0.028, HR 1.912) were the significant prognostic factors for RFS.ConclusionsOur study demonstrated the superiority of adjuvant CCRT over chemotherapy for improving RFS in curatively resected BTC.

Highlights

Biliary tract cancers (BTC) have a poor prognosis even after curative resection because of frequent local and distant recurrences
We reviewed the medical records retrospectively for the following characteristics: age, gender, date of death or the last follow-up visit, date of recurrence, the Karnofsky performance status (KPS), the Charlson comorbidity index (CCI), tumor location, histologic features, pathologic stage based on criteria from the American Joint Committee on Cancer (AJCC), 7th edition, lymph node (LN) status, resection margin status, the preoperative carbohydrate antigen 19–9 (CA19–9) levels as tumor markers, pattern of recurrence, and adjuvant treatment including chemotherapeutic agents
Our study has demonstrated the superiority of adjuvant concurrent chemoradiotherapy (CCRT) over chemotherapy for improving recurrence-free survival (RFS) in curatively resected BTC

Summary

Introduction

Biliary tract cancers (BTC) have a poor prognosis even after curative resection because of frequent local and distant recurrences. The importance of adjuvant therapy in BTC has been advocated to improve outcomes. Biliary tract cancers (BTC) are a heterogeneous group of neoplasms that includes cholangiocarcinoma and gallbladder cancer [1]. These cancers have a poor prognosis of low five-year survival rates in the range of 5 to 15% [2]. Adjuvant treatments, including chemotherapy, radiotherapy, and chemoradiotherapy, may decrease the recurrence rate and improve overall survival (OS). Several single-center retrospective studies have demonstrated a survival benefit of adjuvant therapy in resected BTC [10,11,12].

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