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Role of adjuvant radiotherapy in extrahepatic bile duct cancer: A multicenter retrospective study (Korean Radiation Oncology Group 18-14)

 Kyubo Kim  ;  Jeong Il Yu  ;  Wonguen Jung  ;  Tae Hyun Kim  ;  Jinsil Seong  ;  Woo Chul Kim  ;  Jin Hwa Choi  ;  Younghee Park  ;  Bae Kwon Jeong  ;  Byoung Hyuck Kim  ;  Tae Gyu Kim  ;  Jin Hee Kim  ;  Hae Jin Park  ;  Hyun Soo Shin  ;  Jung Ho Im  ;  Jin Seok Heo  ;  Joon Oh Park  ;  Jin-Young Jang  ;  Do-Youn Oh  ;  Sang Myung Woo  ;  Woo Jin Lee  ;  Eui Kyu Chie 
 EUROPEAN JOURNAL OF CANCER, Vol.157 : 31-39, 2021-11 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms / mortality ; Bile Duct Neoplasms / pathology ; Bile Duct Neoplasms / therapy* ; Bile Ducts, Extrahepatic* ; Chemoradiotherapy, Adjuvant ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies
Adjuvant radiotherapy ; Chemoradiotherapy ; Extrahepatic bile duct cancer
Purpose: To evaluate the role of adjuvant radiotherapy (RT) after curative resection in patients with extrahepatic bile duct (EHBD) cancer.

Methods: Between January 2000 and December 2015, 1475 patients with EHBD cancer who underwent curative resection were accrued from 14 institutions in Korea. Among these, 959 patients did not receive any adjuvant therapy (RT(-) group), while 516 underwent postoperative RT with or without chemotherapy (RT(+) group).

Results: The median age was 67 years. Nodal involvement was present in 482 patients (32.7%), and resection margin was involved in 293 patients (19.9%). RT(+) group had more patients with proximal tumours, advanced tumours, nodal involvement, perineural invasion, and involved resection margin than RT(-) group (all p < 0.001). With a median follow-up of 36 months, there were 211 locoregional recurrences, 307 distant metastases and 322 combined locoregional and distant failures. On multivariate analysis incorporating age, tumour location, differentiation, pT classification, pN classification, perineural invasion and resection margin, adjuvant RT was associated with improved overall survival (hazard ratio, 0.74; 95% confidence interval, 0.63-0.86; p < 0.001). When RT(+) group was separated into RT alone, concurrent chemoradiotherapy (CCRT) and CCRT followed by chemotherapy, the greatest benefit was observed in patients treated with CCRT followed by chemotherapy (hazard ratio, 0.52; 95% confidence interval, 0.41-0.68).

Conclusions: Adjuvant RT combined with chemotherapy improved survival outcomes of resected EHBD cancer patients. Considering the greatest benefit observed in patients receiving CCRT followed by chemotherapy, a randomised controlled trial comparing chemotherapy alone and CCRT followed by chemotherapy is urgently needed.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Im, Jung Ho(임정호)
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