title: Magnitude of combination therapy of radical resection and external beam radiotherapy for patients with carcinomas of the extrahepatic bile duct and gallbladder.
abstract: The present study sought to identify the therapeutic efficacy of adjuvant external beam radiotherapy (EBRT) for carcinomas of the extrahepatic bile duct (EHBD) and gallbladder. Twenty-one patients with pathologically verified EHBD carcinoma and 18 patients with gallbladder carcinoma were analyzed retrospectively by Cox regression analysis for predictors of survival. The overall 5-year survival rates after resection were 33% for EHBD carcinoma and 56% for gallbladder carcinoma. The overall 5-year survival rate for EHBD carcinoma was 60% in 8 patients without microscopic residual disease (R0), 15% in 9 patients with microscopic residual tumor (R1), and 0% in 4 patients with macroscopic residual tumor (R2). The overall 5-year survival rate of gallbladder carcinoma patients was also decreased with R status equal to 73%, 40%, and 0% for R0, R1 and R2, respectively. Adjuvant radiotherapy significantly improved the 5-year survival rate in 7 patients with R1 disease of EHBD carcinoma (P = .035), compared with survival in 2 patients who underwent resection alone. However, no significant difference was noted in the 5-year survival rate between the resection plus EBRT group and the resection alone group for gallbladder carcinoma. Multivariate analysis revealed that histopathologic grade (G) was an independent predictor of survival for EHBD carcinoma and that direct invasion of liver parenchyma was a predictor of survival for gallbladder carcinoma. This study suggests that curative resection provides the best survival for patients with EHBD and gallbladder carcinoma, and that radiotherapy may play a beneficial role in controlling local-regional residual EHBD carcinoma tumors. However, new strategies for adjuvant therapy are needed to improve survival in patients with gallbladder carcinoma.
authors.affiliation: Department of Surgery, Kanazawa Medical Center, Shimoishibiki, Ishikawa, Japan. ITO4164@hotmail.com
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
authors.forename: Koji
authors.initials: K
authors.lastname: Nishijima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kurosaka
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takegawa
authors.forename: Masato
authors.initials: M
authors.lastname: Kiriyama
authors.forename: Shotaro
authors.initials: S
authors.lastname: Dohba
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Kojima
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Saitoh
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D001707:Biopsy, Needle; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002763:Cholecystectomy / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome