title: Cholangiocarcinoma: clinical significance of tumor location along the extrahepatic bile duct.
abstract: OBJECTIVE
  To define the criteria for resection and/or radiation therapy (RT) of extrahepatic bile duct cancer.
  
  
  METHODS
  Of 81 patients with extrahepatic bile duct cancer treated from 1983 to 1992, those with proximal duct lesions (n = 56) underwent RT and/or resection or palliative care, and those with distal lesions (n = 25) underwent resection with or without RT. Follow-up was available 3-114 months (median, 28 months).
  
  
  RESULTS
  Patients with distal bile duct cancer lived longer than patients with proximal bile duct cancer (survival with Kaplan-Meier analysis, 53% vs 13% at 5 years, respectively, P < .01). Median survival in patients with proximal cancer after RT was more than double that without RT (17 months vs 6 months, respectively, regardless of stage [P = .01]); survival was not significantly different after resection. In patients with distal cancer, RT after resection made no significant difference in median survival (68 months).
  
  
  CONCLUSIONS
  Patients with proximal cancer should undergo primary RT, and expectations should be limited. Patients with distal cancer should undergo resection, and RT may not be needed.
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010347:Patient Care Planning; D018579:Patient Selection; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D007496:Iridium Radioisotopes