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Abstract
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.

fig1 절제연 양성 환자에서 방사선치료 여부에 따른 생존율

fig2 림프절 양성 환자에서 방사선치료 여부에 따른 생존율

Affiliations

Kyubo Kim 1, Jung Il Yu 2, Wonguen Jung 1, Tae Hyun Kim 3, Jinsil Seong 4, Woo Chul Kim 5, Jin Hwa Choi 6, Younghee Park 7, Bae Kwon Jeong 8, Byoung Hyuck Kim 9, Tae Gyu Kim 10, Jin Hee Kim 11, Hae Jin Park 12, Hyun Soo Shin 13, Jung Ho Im 14, Jin Seok Heo 15, Joon Oh Park 16, Jin-Young Jang 17, Do-Youn Oh 18, Sang Myung Woo 19, Woo Jin Lee 19, Eui Kyu Chie 20
1Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, South Korea.
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
3Center for Proton Therapy, National Cancer Center, Goyang, South Korea.
4Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
5Department of Radiation Oncology, Inha University School of Medicine, Incheon, South Korea.
6Department of Radiation Oncology, Chung-Ang University College of Medicine, Seoul, South Korea.
7Department of Radiation Oncology, Soonchunhyang University College of Medicine, Seoul, South Korea.
8Department of Radiation Oncology, Gyeongsang National University College of Medicine, Jinju, South Korea.
9Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
10Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
11Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, South Korea.
12Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, South Korea.
13Department of Radiation Oncology, CHA University School of Medicine, Seongnam, South Korea.
14Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, CHA University School of Medicine, Seongnam, South Korea.
15Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
16Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
17Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
18Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
19Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea.
20Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: ekchie93@snu.ac.kr.