Postoperative chemoradiotherapy for extrahepatic bile duct cancer

Int J Radiat Oncol Biol Phys. 2011 Mar 1;79(3):696-704. doi: 10.1016/j.ijrobp.2009.12.031. Epub 2010 May 24.

Abstract

Purpose: To evaluate the effect of postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy and to identify the prognostic factors that influence survival in patients with extrahepatic bile duct cancer.

Methods and materials: We retrospectively analyzed the data from 101 patients with extrahepatic bile duct cancer who had undergone postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy. Of the 101 patients, 52 (51%) had undergone complete resection (R0 resection) and 49 (49%) had microscopic or macroscopic residual tumors (R1 or R2 resection). The median radiation dose was 50 Gy. Also, 85 patients (84%) underwent concurrent chemotherapy with 5-fluorouracil.

Results: The median follow-up period was 47 months for the surviving patients. The 5-year overall survival rate was 34% for all patients. A comparison between patients with R0 and R1 resection indicated no significant difference in the 5-year overall survival (44% vs. 33%, p=.2779), progression-free survival (35% vs. 22%, p=.3107), or locoregional progression-free survival (75% vs. 63%, p=.2784) rates. An analysis of the first failure site in the 89 patients with R0 or R1 resection indicated isolated locoregional recurrence in 7 patients. Elevated postoperative carbohydrate antigen 19-9 level was an independent prognostic factor for overall survival (p=.001) and progression-free survival (p=.033). A total of 3 patients developed Grade 3 or greater late toxicity.

Conclusion: Adjuvant concurrent chemoradiotherapy using three-dimensional conformal radiotherapy appears to improve locoregional control and survival in extrahepatic bile duct cancer patients with R1 resection. The postoperative carbohydrate antigen 19-9 level might be a useful prognostic marker to select patients for more intensified adjuvant therapy.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Antimetabolites, Antineoplastic / therapeutic use
  • Bile Duct Neoplasms / blood
  • Bile Duct Neoplasms / drug therapy*
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / radiotherapy*
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Extrahepatic* / surgery
  • CA-19-9 Antigen / blood
  • Combined Modality Therapy / methods
  • Female
  • Fluorouracil / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / blood
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm, Residual
  • Radiotherapy Dosage
  • Radiotherapy, Conformal*
  • Republic of Korea
  • Retrospective Studies
  • Survival Analysis

Substances

  • Antimetabolites, Antineoplastic
  • CA-19-9 Antigen
  • Fluorouracil