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For: Palta M, Willett C, Patel P, Uronis H, Tyler D, Czito B. Carcinoma of the Ampulla of Vater: Patterns of Failure after Resection and Possible Benefit of Adjuvant Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

For:	Palta M, Willett C, Patel P, Uronis H, Tyler D, Czito B. Carcinoma of the Ampulla of Vater: Patterns of Failure after Resection and Possible Benefit of Adjuvant Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

Number	Cited by Other Article(s)
1	Adjuvant radio-chemotherapy for extrahepatic biliary tract cancers. BMC Cancer 2011;11:267. [PMID: 21702920 PMCID: PMC3141778 DOI: 10.1186/1471-2407-11-267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 06/24/2011] [Indexed: 12/16/2022] Open Abstract BACKGROUND Extrahepatic biliary duct cancers (EBDC) are uncommon malignancies characterized by a poor prognosis with high rate of loco-regional recurrence. The purpose of the present study is to assess the feasibility and the potential impact of adjuvant radiotherapy (RT) in a series of patients treated in one institution. METHODS Twenty three patients with non-metastatic bile duct cancer treated surgically with curative intent (4 gallbladder, 7 ampullary and 12 cholangiocarcinoma) received 3D conformal external beam RT to a median total dose of 50.4 Gy. Concurrent chemotherapy based on 5-FU was delivered to 21 patients (91%). Surgical margins were negative in 11 patients (48%), narrow in 2 (9%), and microscopically involved in 8 (35%). Eleven patients (55%) had metastatic nodal involvement. The average follow-up time for all patients was 30 months (ranging from 3-98). RESULTS Acute gastrointestinal grade 2 toxicity (RTOG scale) was recorded in 2 patients (9%). Nausea or vomiting grade 1 and 2 was observed in 8 (35%) and 2 patients (9%) respectively. Only one patient developed a major late radiation-induced toxicity. The main pattern of recurrence was both loco-regional and distant (liver, peritoneum and/or lung). No difference was observed in loco-regional control according to the tumor location. The 5-year actuarial loco-regional control rate was 48.3% (67% and 30% for patients operated on with negative and positive/narrow/unknown margins respectively, p=0.04). The 5-year actuarial overall survival was of 35.9% for the entire group (61.4% in case of negative margins and 16.7% in case of positive/narrow/unknown margins, p=0.07). CONCLUSIONS Postoperative RT with 50-60 Gy is feasible with acceptable acute and late toxicities. The potential benefit observed in our series may support the use of adjuvant RT in patients with locally advanced disease. Prospective randomized trials are warranted to confirm definitively the role of RT in this tumor location. Collapse Key Words Collapse MESH Headings Aged Antineoplastic Combined Chemotherapy Protocols/therapeutic use Bile Duct Neoplasms/drug therapy Bile Duct Neoplasms/mortality Bile Duct Neoplasms/radiotherapy Bile Duct Neoplasms/surgery Bile Duct Neoplasms/therapy Bile Ducts, Extrahepatic/pathology Chemotherapy, Adjuvant Cholangiocarcinoma/drug therapy Cholangiocarcinoma/mortality Cholangiocarcinoma/radiotherapy Cholangiocarcinoma/surgery Cholangiocarcinoma/therapy Cisplatin/administration & dosage Combined Modality Therapy Digestive System Surgical Procedures Female Fluorouracil/administration & dosage Humans Kaplan-Meier Estimate Leucovorin/administration & dosage Lymphatic Irradiation Male Middle Aged Radiotherapy, Adjuvant Radiotherapy, Conformal Retrospective Studies Collapse Grants Collapse Affiliation(s) Collapse

Number

Cited by Other Article(s)

Adjuvant radio-chemotherapy for extrahepatic biliary tract cancers. BMC Cancer 2011;11:267. [PMID: 21702920 PMCID: PMC3141778 DOI: 10.1186/1471-2407-11-267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 06/24/2011] [Indexed: 12/16/2022] Open

Abstract

BACKGROUND

Extrahepatic biliary duct cancers (EBDC) are uncommon malignancies characterized by a poor prognosis with high rate of loco-regional recurrence. The purpose of the present study is to assess the feasibility and the potential impact of adjuvant radiotherapy (RT) in a series of patients treated in one institution.

METHODS

Twenty three patients with non-metastatic bile duct cancer treated surgically with curative intent (4 gallbladder, 7 ampullary and 12 cholangiocarcinoma) received 3D conformal external beam RT to a median total dose of 50.4 Gy. Concurrent chemotherapy based on 5-FU was delivered to 21 patients (91%). Surgical margins were negative in 11 patients (48%), narrow in 2 (9%), and microscopically involved in 8 (35%). Eleven patients (55%) had metastatic nodal involvement. The average follow-up time for all patients was 30 months (ranging from 3-98).

RESULTS

Acute gastrointestinal grade 2 toxicity (RTOG scale) was recorded in 2 patients (9%). Nausea or vomiting grade 1 and 2 was observed in 8 (35%) and 2 patients (9%) respectively. Only one patient developed a major late radiation-induced toxicity. The main pattern of recurrence was both loco-regional and distant (liver, peritoneum and/or lung). No difference was observed in loco-regional control according to the tumor location. The 5-year actuarial loco-regional control rate was 48.3% (67% and 30% for patients operated on with negative and positive/narrow/unknown margins respectively, p=0.04). The 5-year actuarial overall survival was of 35.9% for the entire group (61.4% in case of negative margins and 16.7% in case of positive/narrow/unknown margins, p=0.07).

CONCLUSIONS

Postoperative RT with 50-60 Gy is feasible with acceptable acute and late toxicities. The potential benefit observed in our series may support the use of adjuvant RT in patients with locally advanced disease. Prospective randomized trials are warranted to confirm definitively the role of RT in this tumor location.

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