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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2020

01-12-2020 | Cholangiocarcinoma | Hepatobiliary Tumors

Patterns of Failure and the Need for Biliary Intervention in Resected Biliary Tract Cancers After Chemoradiation

Authors: Edward Christopher Dee, BS, Morgan E. Freret, MD, PhD, Nora Horick, MS, Ann C. Raldow, MD, MPH, Lipika Goyal, MD, MPhil, Andrew X. Zhu, MD, PhD, Aparna R. Parikh, MD, David P. Ryan, MD, Jeffrey W. Clark, MD, Jill N. Allen, MD, Cristina R. Ferrone, MD, Carlos Fernandez-del Castillo, MD, Kenneth K. Tanabe, MD, Lorraine C. Drapek, DNP, Theodore S. Hong, MD, Motaz Qadan, MD, PhD, Jennifer Y. Wo, MD

Published in: Annals of Surgical Oncology | Issue 13/2020

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Abstract

Background

This study assessed patterns of failure and rates of subsequent biliary intervention among patients with resected biliary tract cancers (BTCs) including gallbladder carcinoma (GBC) and extra- and intrahepatic cholangiocarcinoma (eCCA and iCCA) treated with adjuvant chemoradiation therapy (CRT).

Methods

In this single-institution retrospective analysis of 80 patients who had GBC (n = 29), eCCA (n = 43), or iCCA (n = 8) treated with curative-intent resection and adjuvant CRT from 2007 to 2017, the median radiation dose was 50.4 Gy (range 36–65 Gy) with concurrent 5-fluorouracil (5-FU) chemotherapy. All but two of the patients received adjuvant chemotherapy. The 2-year locoregional failure (LRF), 2-year recurrence-free survival (RFS), and 2-year overall survival (OS), and univariate predictors of LRF, RFS, and OS were calculated for the entire cohort and for a subgroup excluding patients with iCCA (n = 72). The predictors of biliary interventions also were assessed.

Results

Of the 80 patients (median follow-up period, 30.5 months; median OS, 33.9 months), 54.4% had American Joint Committee on Cancer (AJCC) stage 1 or 2 disease, 57.1% were lymph node-positive, and 66.3% underwent margin-negative resection. For the entire cohort, 2-year LRF was 23.8%, 2-year RFS was  43.7%, and 2-year OS was 62.1%.  When patients with iCCA were excluded, the 2-year LRF was 22.6%, the 2-year RFS was 43.9%, and the 2-year OS was 59.2%. In the overall and subgroup univariate analyses, lymph node positivity was associated with greater LRF, whereas resection margin was not. Biliary intervention was required for 12 (63.2%) of the 19 patients with LRF versus 11 (18%) of the 61 patients without LRF (P < 0.001). Of the 12 patients with LRF who required biliary intervention, 4 died of biliary complications.

Conclusions

The LRF rates remained significant despite adjuvant CRT. Lymph node positivity may be associated with increased risk of LRF. Positive margins were not associated with greater LRF, suggesting that CRT may mitigate LRF risk for this group. An association between LRF and higher rates of subsequent biliary interventions was observed, which may yield significant morbidity. Novel strategies to decrease the rates of LRF should be considered.
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Metadata
Title
Patterns of Failure and the Need for Biliary Intervention in Resected Biliary Tract Cancers After Chemoradiation
Authors
Edward Christopher Dee, BS
Morgan E. Freret, MD, PhD
Nora Horick, MS
Ann C. Raldow, MD, MPH
Lipika Goyal, MD, MPhil
Andrew X. Zhu, MD, PhD
Aparna R. Parikh, MD
David P. Ryan, MD
Jeffrey W. Clark, MD
Jill N. Allen, MD
Cristina R. Ferrone, MD
Carlos Fernandez-del Castillo, MD
Kenneth K. Tanabe, MD
Lorraine C. Drapek, DNP
Theodore S. Hong, MD
Motaz Qadan, MD, PhD
Jennifer Y. Wo, MD
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08967-9

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