Impact of radiation dose in postoperative radiotherapy after R1 resection for extrahepatic bile duct cancer: long term results from a single institution

American Radium Society (ARS) Appropriate Use Criteria (AUC) for Extrahepatic Cholangiocarcinoma

Although uncommon, extrahepatic cholangiocarcinoma (EHCC) is a deadly malignancy, and the treatment approaches remain controversial. While surgery remains the only cure, few patients are candidates for resection up front, and there are high rates of both local and distant failure following resection. Herein, we systematically review the available evidence regarding treatment approaches for patients with EHCC, including surgery, radiation, and chemotherapy. The evidence regarding treatment outcomes was assessed using the Population, Intervention, Comparator, Outcome, and Study design (PICOS) framework. A summary of recommendations based on the available literature is outlined for specific clinical scenarios encountered by providers in the clinic to guide the management of these patients.

The Role of Adjuvant Chemoradiotherapy in Nonhilar Extrahepatic Bile Duct Cancer: A Long-Term Single-Institution Analysis

PURPOSE

Despite frequent use in the clinical setting, especially for patients with high-risk factors for relapse, the role of adjuvant treatment has not been clarified in nonhilar extrahepatic bile duct cancer (NH-EHBDC). The goal of this study is to identify the role of adjuvant chemoradiotherapy (CRT) in NH-EHBDC patients after radical surgery.

METHODS AND MATERIALS

Patients with NH-EHBDC who underwent radical surgery from July 2007 to December 2018 were reviewed retrospectively. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Subgroup analyses were performed to further identify the role of adjuvant CRT.

RESULTS

Three hundred twenty-eight patients were accrued. At a median follow-up of 37.1 months (range, 1.0-144.2 months), the 3-year LRRFS, DMFS, DFS, and OS were 63.4%, 59.0%, 53.2%, and 67.5%, respectively. In multivariate analysis, adjuvant CRT was an independent prognostic factor for LRRFS, DMFS, DFS, and OS (P < .05). For patients with nodal involvement, pT3 stage, tumor size ≥ 5 cm, poorly differentiated tumor, and R1 resection, adjuvant CRT significantly improved DFS (P < .05).

CONCLUSIONS

In patients with NH-EHBDC, adjuvant CRT significantly improved LRRFS and DFS. For patients with risk factors such as nodal involvement, pT3 stage, poorly differentiated tumor, tumor size ≥ 5 cm, or R1 resection, adjuvant CRT might contribute to improve treatment outcomes.

Outcome of localized liver-bile duct rhabdomyosarcoma according to local therapy: A report from the European Paediatric Soft-Tissue Sarcoma Study Group (EpSSG)-RMS 2005 study

OBJECTIVES

To evaluate the impact of local therapies on the outcome of patients with liver-bile duct rhabdomyosarcoma (LBDRMS).

METHODS

Data of 30 patients included in the EpSSG-RMS 2005 study were analyzed.

RESULTS

The median age at diagnosis was 3 years (11 months-8 years). All patients had non-alveolar histology. Fifteen patients had a tumor > 5 cm and six had enlarged regional lymph nodes on imaging. Eight patients (27%) had primary surgery (1 R0). Six of them received external beam radiotherapy (EBRT). All are in first complete remission (CR1) except one (R1, EBRT⁺ , local relapse, death). Six patients (20%) received EBRT without surgery: one had local relapse and died. Sixteen patients (53%) underwent delayed surgery, with 12 achieving R0 margins, which were higher than those in the primary surgery group (P = 0.003). Three patients with R0 margins received EBRT; one had a metastatic relapse and died. Nine patients with R0 resection did not receive EBRT, three relapsed locally (two deaths). Four R1 patients received additional EBRT without relapses. Local relapse occurred in two among 19 patients with EBRT and three among 11 without EBRT (P = 0.326). At a median follow-up of 61 months (48-84 months), five patients died; all had a tumor size > 5 cm (P = 0.01). The five-year overall survival was 85% (95% CI, 65-94), and event-free survival was 76% (95% CI, 54-89).

CONCLUSION

This analysis did not show any significant difference in outcome between irradiated and nonirradiated patients. Local relapse in LBDRMS is related to initial tumor size and is often fatal.