Survival Outcomes in Resected Extrahepatic Cholangiocarcinoma: Effect of Adjuvant Radiotherapy in a Surveillance, Epidemiology, and End Results Analysis

• Published in: International journal of radiation oncology, biology, physics Vol. 81; no. 1; pp. 189 - 198
• Main Authors: Vern-Gross, Tamara Z., D.O, Shivnani, Anand T., M.D, Chen, Ke, Ph.D, Lee, Christopher M., M.D, Tward, Jonathan D., M.D., Ph.D, MacDonald, O. Kenneth, M.D, Crane, Christopher H., M.D, Talamonti, Mark S., M.D, Munoz, Louis L., M.D., F.A.C.R.O, Small, William, M.D., F.A.C.R.O
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; and End Results program; bile duct; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - radiotherapy; Bile Duct Neoplasms - surgery; Bile Ducts, Extrahepatic - pathology; Bile Ducts, Extrahepatic - surgery; BILIARY TRACT; Biological and medical sciences; Cause of Death; CHEMOTHERAPY; Cholangiocarcinoma; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Cholangiocarcinoma - radiotherapy; Cholangiocarcinoma - surgery; DIAGNOSIS; DIGESTIVE SYSTEM; DISEASES; EPIDEMIOLOGY; Extrahepatic; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hematology, Oncology and Palliative Medicine; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; MATHEMATICS; Medical sciences; MEDICINE; Middle Aged; MULTIVARIATE ANALYSIS; NEOPLASMS; NUCLEAR MEDICINE; Proportional Hazards Models; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Adjuvant - mortality; REGRESSION ANALYSIS; Retrospective Studies; SEER; SEER Program; STATISTICS; SURGERY; Surveillance; SURVIVAL TIME; THERAPY; Treatment Outcome; Tumors; Young Adult; Extrahepatic; Surveillance; and End Results program; bile duct; SEER; Radiotherapy; Epidemiology; Cholangiocarcinoma; Biliary tract; Prognosis; Digestive system; Adjuvant treatment; Hepatic disease; Malignant tumor; Biliary tract disease; Survival; Malignant cholangioma; Digestive diseases; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.05.001

Purpose The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT. Methods and Materials Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection. Results The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively ( p < .001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease. Conclusion Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database.