Clinical Target Volume in Biliary Carcinoma: A Systematic Review of Pathological Studies.
Radiotherapy is a treatment option for both adjuvant and neo-adjuvant settings for biliary tract cancer. Guidelines on the delineation of the target volume of lymph nodes are lacking; only generic indications are available, without specific recommendations for different primary tumour locations (e.g. intrahepatic, extrahepatic biliary tract or gallbladder cancer). The aim of this study was to systematically review available literature to provide recommendations on lymph node target volume delineation in patients with unresectable biliary tumour.



A systematic search of electronic databases was performed up to July 2016. The primary outcome measure was the rate of lymph node involvement according to the location of primary biliary tumour. Sites with ≥5% of nodal metastases were considered in the clinical target volume for radiotherapy planning.



Twelve studies (1075 patients) were included. The most frequent site of lymph node metastasis in intrahepatic biliary tree carcinoma was retroportal (61.1%, 95% confidence interval (CI)=50.7-70-6%). Other frequently involved lymph nodes were along the hepatoduodenal ligament [frequency=38.7%, 95% CI=31.0-47.0%], those along the common hepatic artery (17.0%, 95% CI=8.2-31.9%) and the hilar nodes (16.9%, 95% CI=13.2-21.4%). In extrahepatic biliary tree cancer, the most frequently involved lymph nodes were the pericholedochal (42.7%, 95% CI=33.8-52.1%) and those along the hepatoduodenal ligament (40.3%, 95% CI=32.4-48.8%). Other commonly involved nodal regions included retroportal lymph nodes (30.9%, 95% CI=23.0-40.1%), pancreaticoduodenal anterior and posterior nodes (30.1%, 95% CI=12.2-57.1%), those along the common hepatic artery (19.7%, 95% CI=11.8-31.0%) and para_aortic nodes (15.2%, 95% CI=8.0-27.0%). The most common site of metastases in gallbladder cancer were the pericholedochal nodes (25.2%, 95% CI=18.6-33.2%), those along the cystic duct (23%, 95% CI=16.6-30.8%), and retroportal nodes (17.1%, 95% CI=11.6-24.5%).



Biliary tract cancer has a high propensity for regional lymphatic metastases. An evidence-based nodal target definition of biliary tract cancer based on primary tumour location was proposed.
Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Ilaria
I
Marinelli
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy alessandra.guido@aosp.bo.it.
Alessandra
A
Guido
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Lorenzo
L
Fuccio
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Andrea
A
Farioli
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Valeria
V
Panni
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Lucia
L
Giaccherini
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Alessandra
A
Arcelli
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Giorgio
G
Ercolani
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Giovanni
G
Brandi
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Silvia
S
Cammelli
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Andrea
A
Galuppi
Radiotherapy Unit, General Oncology Unit, Giovanni Paolo II Foundation, Campobasso, Italy.
Gabriella
G
Macchia
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Rezarta
R
Frakulli
Department of Radiotherapy, Sacred Heart Catholic University, Rome, Italy.
Gian C
GC
Mattiucci
Department of Radiotherapy, Sacred Heart Catholic University, Rome, Italy.
Francesco
F
Cellini
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Milly
M
Buwenge
Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
Matteo
M
Renzulli
Radiotherapy Unit, General Oncology Unit, Giovanni Paolo II Foundation, Campobasso, Italy.
Francesco
F
Deodato
Medical Physics Unit, Giovanni Paolo II Foundation, Campobasso, Italy.
Savino
S
Cilla
Department of Radiotherapy, Sacred Heart Catholic University, Rome, Italy.
Vincenzo
V
Valentini
Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Vincenzo
V
Tombolini
Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
Rita
R
Golfieri
Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Alessio G
AG
Morganti
D001661:Biliary Tract Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D019317:Evidence-Based Medicine; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy / Q000379:methods; D009362:Neoplasm Metastasis; D011880:Radiotherapy Planning, Computer-Assisted; D012107:Research Design; D016896:Treatment Outcome
Lymph node metastasis; biliary tract cancer; clinical target volume; review