title: Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  Extrahepatic cholangiocarcinoma is a rare malignancy. Despite radical resection, survival remains poor, with high rates of local and distant failure. To clarify the role of radiotherapy with chemotherapy, we performed a retrospective analysis of resected patients who had undergone chemoradiotherapy.
  
  
  METHODS
  A total of 45 patients (13 with proximal and 32 with distal disease) underwent resection plus radiotherapy (median dose, 50.4 Gy). All but 1 patient received concurrent fluoropyrimidine-based chemotherapy. The median follow-up was 30 months for all patients and 40 months for survivors.
  
  
  RESULTS
  Of the 45 patients, 33 underwent adjuvant radiotherapy, and 12 were treated neoadjuvantly. The 5-year actuarial overall survival, disease-free survival, metastasis-free survival, and locoregional control rates were 33%, 37%, 42%, and 78%, respectively. The median survival was 34 months. No patient died perioperatively. Patient age </=60 years and perineural involvement adversely affected survival on univariate analysis. Patients undergoing R0 resection had a significantly improved rate of local control but no survival advantage. Despite having more advanced disease at presentation, patients treated neoadjuvantly had a longer survival (5-year survival 53% vs. 23%, p = 0.16) and similar rates of Grade 2-3 surgical morbidity (16% vs. 33%, p = 0.24) compared with those treated in the postoperative setting.
  
  
  CONCLUSIONS
  These study results suggest a possible local control benefit from chemoradiotherapy combined with surgery in patients with advanced, resected biliary cancer. Furthermore, our results suggest that a treatment strategy that includes preoperative chemoradiotherapy might result in improved tumor resectability with similar surgical morbidity compared with patients treated postoperatively, as well as potentially improved survival outcomes. Distant failure remains a significant failure pattern, suggesting the need for more effective systemic therapy.
authors.affiliation: Department of Radiation Oncology, Division of Medical Oncology and Transplantation, Duke University Medical Center, Durham, NC, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Nelson
authors.forename: A Paiman
authors.initials: AP
authors.lastname: Ghafoori
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Willett
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: Herbert I
authors.initials: HI
authors.lastname: Hurwitz
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Bendell
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morse
authors.forename: Robert W
authors.initials: RW
authors.lastname: Clough
authors.forename: Brian G
authors.initials: BG
authors.lastname: Czito
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005472:Fluorouracil