Postoperative chemoradiotherapy for extrahepatic bile duct cancer.
OBJECTIVE
To evaluate the effect of postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy and to identify the prognostic factors that influence survival in patients with extrahepatic bile duct cancer.


METHODS
We retrospectively analyzed the data from 101 patients with extrahepatic bile duct cancer who had undergone postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy. Of the 101 patients, 52 (51%) had undergone complete resection (R0 resection) and 49 (49%) had microscopic or macroscopic residual tumors (R1 or R2 resection). The median radiation dose was 50 Gy. Also, 85 patients (84%) underwent concurrent chemotherapy with 5-fluorouracil.


RESULTS
The median follow-up period was 47 months for the surviving patients. The 5-year overall survival rate was 34% for all patients. A comparison between patients with R0 and R1 resection indicated no significant difference in the 5-year overall survival (44% vs. 33%, p=.2779), progression-free survival (35% vs. 22%, p=.3107), or locoregional progression-free survival (75% vs. 63%, p=.2784) rates. An analysis of the first failure site in the 89 patients with R0 or R1 resection indicated isolated locoregional recurrence in 7 patients. Elevated postoperative carbohydrate antigen 19-9 level was an independent prognostic factor for overall survival (p=.001) and progression-free survival (p=.033). A total of 3 patients developed Grade 3 or greater late toxicity.


CONCLUSIONS
Adjuvant concurrent chemoradiotherapy using three-dimensional conformal radiotherapy appears to improve locoregional control and survival in extrahepatic bile duct cancer patients with R1 resection. The postoperative carbohydrate antigen 19-9 level might be a useful prognostic marker to select patients for more intensified adjuvant therapy.
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jin-hong
JH
Park
Eun Kyung
EK
Choi
Seung Do
SD
Ahn
Sang-wook
SW
Lee
Si Yeol
SY
Song
Sang Min
SM
Yoon
Young Seok
YS
Kim
Yu Sun
YS
Lee
Sung-Gyu
SG
Lee
Shin
S
Hwang
Young-Joo
YJ
Lee
Kwang-Min
KM
Park
Tae Won
TW
Kim
Heung Moon
HM
Chang
Jae-Lyun
JL
Lee
Jong Hoon
JH
Kim
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D018395:CA-19-9 Antigen / Q000097:blood; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality; D018365:Neoplasm, Residual; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D056910:Republic of Korea; D012189:Retrospective Studies; D016019:Survival Analysis
D000964:Antimetabolites, Antineoplastic; D018395:CA-19-9 Antigen; D005472:Fluorouracil