title: Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  The prognosis for patients with extrahepatic bile duct cancer remains poor. The purpose of this study was to evaluate our initial results with preoperative chemoradiation for extrahepatic cholangiocarcinoma, in the context of our experience with conventional treatment of this disease over the past 13 years.
  
  
  METHODS
  From 1983 through 1996, analysis of all patients treated for extrahepatic cholangiocarcinoma was performed.
  
  
  RESULTS
  Of 91 total patients, 51 had unresectable disease and 40 underwent resection. Median survival was significantly different for patients who underwent resection (22.2 months) versus those treated palliatively (10.7 months; P <0.0001). Nine patients underwent preoperative chemoradiation (5 perihilar, 4 distal) prior to resection. Three patients in the preoperative chemoradiation group had a pathologic complete response, while the remainder showed varying degrees of histologic response to treatment. The rate of margin-negative resection was 100% for the preoperative chemoradiation group versus 54% for the group who did not receive preoperative chemoradiation (P <0.01). There were no major intra-abdominal complications in the patients treated with preoperative chemoradiation.
  
  
  CONCLUSIONS
  These results suggest that preoperative chemoradiation for extrahepatic bile duct cancer can be performed safely, produces significant antitumor response, and may improve the ability to achieve tumor-free resection margins. Additional trials of preoperative chemoradiation are warranted.
authors.affiliation: Division of Surgical Oncology, University of Louisville-James Graham Brown Cancer Center, Kentucky 40202, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: McMasters
authors.forename: T M
authors.initials: TM
authors.lastname: Tuttle
authors.forename: S D
authors.initials: SD
authors.lastname: Leach
authors.forename: T
authors.initials: T
authors.lastname: Rich
authors.forename: K R
authors.initials: KR
authors.lastname: Cleary
authors.forename: D B
authors.initials: DB
authors.lastname: Evans
authors.forename: S A
authors.initials: SA
authors.lastname: Curley
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007582:Jejunostomy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome