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01-11-2008 | Gastrointestinal Oncology

Extrahepatic Bile Duct Adenocarcinoma: Patients at High-Risk for Local Recurrence Treated with Surgery and Adjuvant Chemoradiation Have an Equivalent Overall Survival to Patients with Standard-Risk Treated with Surgery Alone

Authors: Yerko Borghero, MD, Christopher H. Crane, MD, Janio Szklaruk, MD, Mauricio Oyarzo, MD, Steven Curley, BS, MD, Peter W. Pisters, MD, Douglas Evans, BS, MD, Eddie K. Abdalla, MD, Melanie B. Thomas, BA, MS, MD, Prajnan Das, MD, Ignacio I. Wistuba, MD, Sunil Krishnan, MD, Jean-Nicolas Vauthey, MD

Published in: Annals of Surgical Oncology | Issue 11/2008

Abstract

Background

Patients with resected extrahepatic bile duct adenocarcinoma who have microscopically positive resection margins and/or pathologic locoregional nodal involvement (R1pN1) have a high-risk of locoregional recurrence, and therefore, we advocate the use of adjuvant chemoradiation. To evaluate the safety and effectiveness of this treatment, we compared survival and side effects outcomes between such patients and patients with negative resection margins and pathologically negative nodes (R0pN0) who did not receive adjuvant treatment.

Methods

Between 1984 and 2005, 65 patients were treated with curative-intended resection for extrahepatic bile duct adenocarcinoma. Patients with tumors arising in the gallbladder and periampullary region were excluded. Pathology and diagnostic images were centrally reviewed. Overall survival and locoregional recurrence outcomes for patients with standard-risk R0pN0 (surgery alone, or S group, n = 23) were compared with those of patients with high locoregional recurrence risk, R1 and/or pN1 (R1pN1) status who received adjuvant chemoradiation (S-CRT group, n = 42).

Results

The median follow-up for the entire group was 31 months. Patients in the S-CRT and S groups had a similar 5-year overall survival (36% vs. 42%, P = .6) and locoregional recurrence (5-year rate: 38% vs. 37%, P = .13). In the S-CRT group, three patients (7%) experienced an acute (grade 3 or more) side effect.

Conclusions

Our finding of a lack of a survival difference between the S and S-CRT groups suggests that for patients with extrahepatic bile duct adenocarcinoma at high risk for locoregional recurrence (i.e., R1 resection or pN1 disease), adjuvant chemoradiation provides an equivalent overall survival despite of these worse prognostic features.

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Title: Extrahepatic Bile Duct Adenocarcinoma: Patients at High-Risk for Local Recurrence Treated with Surgery and Adjuvant Chemoradiation Have an Equivalent Overall Survival to Patients with Standard-Risk Treated with Surgery Alone
Authors: Yerko Borghero, MD
Christopher H. Crane, MD
Janio Szklaruk, MD
Mauricio Oyarzo, MD
Steven Curley, BS, MD
Peter W. Pisters, MD
Douglas Evans, BS, MD
Eddie K. Abdalla, MD
Melanie B. Thomas, BA, MS, MD
Prajnan Das, MD
Ignacio I. Wistuba, MD
Sunil Krishnan, MD
Jean-Nicolas Vauthey, MD
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-008-9998-7

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Extrahepatic Bile Duct Adenocarcinoma: Patients at High-Risk for Local Recurrence Treated with Surgery and Adjuvant Chemoradiation Have an Equivalent Overall Survival to Patients with Standard-Risk Treated with Surgery Alone

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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