Adjuvant Concurrent Chemoradiotherapy in Extrahepatic Cholangiocarcinoma

Conference Correspondent

Six months of adjuvant capecitabine is the standard of care in patients with resected extrahepatic cholangiocarcinoma (EHC).1 However, adjuvant radiation therapy benefit is not well-defined. Using cases from the National Cancer Database (NCDB), this study aimed to evaluate survival outcomes with adjuvant chemoradiotherapy compared with chemotherapy in EHC.2 Patients with resected stage I-III EHC between years 2004 and 2013 were identified from the NCDB. Patients who had undergone neoadjuvant therapy were excluded from this analysis. Univariate and multivariable analyses were conducted, and Kaplan-Meier curves were used to compare overall survival (OS) based on treatment received. A total of 236 patients with EHC were identified. Distribution of patients across stages I-III was 28.8% (N = 68), 56.8% (N = 134), and 14.4% (N = 34), respectively.

Adjuvant chemotherapy was given in 37.7% (N = 89) of patients and adjuvant chemoradiotherapy in 62.3% (N = 147). The median dose of radiation was 50.4 Gy. Adjuvant chemoradiotherapy was mostly given in regional node-positive disease (P = .016) and in patients with negative surgical margins (P = .002). The use of adjuvant chemoradiotherapy was associated with improved OS compared with chemotherapy alone in univariate (hazard ratio, 0.64; P = .019) and multivariable (hazard ratio, 0.65; P = .030) analysis. Median survival and 1-year OS for patients who received chemoradiotherapy was 33.8 months and 87.7%, respectively, compared with 23.8 months and 75.5% with chemotherapy alone.

The authors concluded that adjuvant chemoradiotherapy was associated with improved survival in patients with resected EHC compared with chemotherapy alone.

References

  1. Primrose JN, et al. Lancet Oncol. 2019;20(5):663-673.
  2. Labib Shaib W, et al. ASCO 2020. Abstract 4583.

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