Role of chemoradiotherapy in advanced biliary cancers.

Abstract

e14694 Background: Patients with metastatic biliary tract cancers have a poor outcome and radiotherapy is administered largely to patients with an intent of palliation. We analyzed our institutional biliary tract cancer database to compare the outcome between chemotherapy alone vs. chemoradiotherapy. Methods: From January 2005 to December 2010, 126 metastatic and inoperable biliary cancer patients were retrospectively analyzed. 59(46.8%) patients received chemoradiotherapy(CRT) and 67(53.1%) patients received chemotherapy alone. Chemotherapy regimens consisted of 5-fluorouracil, gemcitabine, or cisplatin. CRT patients received 3D-CRT with a median dose of 30 Gy (range, 25-35Gy ) at 1.8-2 Gy per fraction per day.Patients were categorized into Gall bladder, extrahepatic or intrahepatic bileduct cancers .The follow-up time was calculated from the time of diagnosis to the date of death or the last contact. Kaplan-Meier analysis was used to calculate the overall survival (OS). Results: Median OS was 6.6 months for all patients. Median OS was 6.9 months (0.8-26.0) for patients treated with chemotherapy alone and 10.2 months (0.8-46.9) for those treated with chemoradiotherapy (p = 0.002). Univariate survival analysis of categorical variables for patients treated with chemoradiotherapy revealed that age, race, gender, location of metastatic site, site of primary tumor ,T stage (T3 v. T4) or nodal stage were not significant. However, ECOG performance status (1 v. 2/3) and the dose of radiation (<30 v. >30 Gy) received were associated with improved survival (p = 0.002, p=0.032). Median OS was 13.2 months for ECOG 1 vs. 4.3 months for ECOG 2/3. Median OS was 12.3 months for patients treated with radiotherapy dose more than 30 Gy vs. 6.4 months for those who received less than 30 Gy. 12/59(20.3%) patients who received chemoradiotherapy lived approximately 2 years longer. Conclusions: Metastatic biliary tract cancer patients with good performance score may benefit from chemoradiotherapy, and this modality did not increase the mortality. Long-term survival was observed in this selected group.