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01-12-2017 | Radiation Oncology

Chemoradiation Therapy for Unresected Extrahepatic Cholangiocarcinoma: A Propensity Score-Matched Analysis

Authors: Anna Torgeson, MD, Shane Lloyd, MD, Dustin Boothe, MD, George Cannon, MD, Ignacio Garrido-Laguna, MD, PhD, Jonathan Whisenant, MD, Mark Lewis, MD, Robin Kim, MD, Courtney Scaife, MD, Randa Tao, MD

Published in: Annals of Surgical Oncology | Issue 13/2017

Abstract

Background

Unresected extrahepatic cholangiocarcinoma (uEHCC) remains a deadly disease. Guidelines for uEHCC recommend either chemotherapy alone (CT) or chemoradiotherapy (CRT). This study used the National Cancer Database (NCDB) to compare outcomes for patients treated with CT and those who underwent CRT.

Methods

Patients with initially diagnosed non-metastatic uEHCC from 2004 to 2014 were identified. Using Chi square analysis, patients who underwent CT were compared with those who received CRT. Uni- and multivariate Cox regression analyses were used to compare characteristics related to survival. Propensity score matching and shared frailty analysis were undertaken to correct for baseline differences between the two groups. Additional analyses were performed to compare survival for the minority of patients who underwent surgery and advanced-stage patients.

Results

The study identified 2996 patients with uEHCC. Chemoradiation was associated with better survival (median survival [MS], 14.5 months; hazard ratio [HR] 0.84; p < 0.001) than CT alone (MS, 12.6 months). Induction of CT before CRT was associated with a trend toward decreased risk of death compared with concurrent CRT (HR 0.81; p = 0.051). For the patients able to undergo surgery after initial treatment, MS was 24.5 months (HR 0.38; p < 0.001) versus 12.2 months for those who had no surgery. For these patients, CRT also was associated with better survival (MS, 31.2 months; HR 0.66; p = 0.001) than CT (MS, 22.1 months). Positive margins at surgery yielded survival equivalent to that with no surgery.

Conclusion

Although CRT may be associated with slightly better survival in uEHCC than CT alone, the majority of the benefit was observed for patients able to undergo eventual surgery.

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Title: Chemoradiation Therapy for Unresected Extrahepatic Cholangiocarcinoma: A Propensity Score-Matched Analysis
Authors: Anna Torgeson, MD
Shane Lloyd, MD
Dustin Boothe, MD
George Cannon, MD
Ignacio Garrido-Laguna, MD, PhD
Jonathan Whisenant, MD
Mark Lewis, MD
Robin Kim, MD
Courtney Scaife, MD
Randa Tao, MD
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 13/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6131-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chemoradiation Therapy for Unresected Extrahepatic Cholangiocarcinoma: A Propensity Score-Matched Analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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