Yasuo Yoshioka1, Kazuhiko Ogawa2, Hirobumi Oikawa3, Hiroshi Onishi4, Nobue Uchida5, Toshiya Maebayashi6, Naoto Kanesaka7, Tetsuro Tamamoto8, Hirofumi Asakura9, Takashi Kosugi10, Kazuo Hatano11, Michio Yoshimura12, Kazunari Yamada13, Sunao Tokumaru14, Kenji Sekiguchi15, Masao Kobayashi16, Toshinori Soejima17, Fumiaki Isohashi1, Kenji Nemoto18, Yasumasa Nishimura19. 1. Department of Radiation Oncology, Osaka University Graduate School of Medicine, Japan. 2. Department of Radiation Oncology, Osaka University Graduate School of Medicine, Japan. Electronic address: kogawa@radonc.med.osaka-u.ac.jp. 3. Department of Radiology, Iwate Medical University, Japan. 4. Department of Radiology, University of Yamanashi, Japan. 5. Department of Radiation Oncology, Shimane University, Japan. 6. Department of Radiology, Nihon University School of Medicine, Tokyo, Japan. 7. Department of Radiology, Tokyo Medical University, Japan. 8. Department of Radiation Oncology, Nara Medical University of Medicine, Japan. 9. Division of Radiation Oncology, Shizuoka Cancer Center, Japan. 10. Department of Radiology, Hamamatsu University School of Medicine, Shizuoka, Japan. 11. Department of Radiation Oncology, Chiba Cancer Center, Japan. 12. Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Japan. 13. Department of Radiation Oncology, Seirei Mikatahara General Hospital, Shizuoka, Japan. 14. Department of Heavy Particle Therapy and Radiation Oncology, Saga University, Japan. 15. Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan. 16. Department of Radiology, Jikei University School of Medicine, Tokyo, Japan. 17. Department of Radiation Oncology, Hyogo Cancer Center, Japan. 18. Department of Radiation Oncology, Yamagata University, Japan. 19. Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka, Japan.
Abstract
PURPOSE: To seek for the possible factors influencing overall survival (OS) with radiotherapy (RT) for biliary tract cancer. MATERIALS AND METHODS: Data were collected retrospectively from RT database of 31 institutions in Japan. All patients underwent at least external beam RT. The factors influencing OS were investigated. RESULTS: Data of 498 patients were analyzed. Median OS of the 212 patients who underwent surgery was significantly better than that of the 286 patients without surgery (31 vs. 15 months, p<0.001). The OS for the R0 or R1 resection group was significantly longer than that for the R2 or non-surgery group, as well as for n0 compared to n1 (all p<0.001). Chemoradiotherapy (CRT), both sequential and concurrent, resulted in a better OS than RT alone for the n1 group (31 vs. 13 months, p<0.001), and marginally better for the R0/R1 group (p=0.065; p=0.054 for concurrent CRT). However, no such benefit was observed for the R2/non-surgical patients. Multivariate analysis identified performance status, clinical stage, and surgery as significant factors. CONCLUSION: Surgery, especially R0/R1 resection, seemed as the gold standard for treatment of biliary tract cancer including RT, even in the highly heterogeneous population obtained from the multicenter retrospective study. The possibility was shown that CRT yielded better survival benefit especially for n1 patients. We recommend that future prospective trials include an arm of adjuvant CRT at least for n1 and possibly R0/R1 patients.
PURPOSE: To seek for the possible factors influencing overall survival (OS) with radiotherapy (RT) for biliary tract cancer. MATERIALS AND METHODS: Data were collected retrospectively from RT database of 31 institutions in Japan. All patients underwent at least external beam RT. The factors influencing OS were investigated. RESULTS: Data of 498 patients were analyzed. Median OS of the 212 patients who underwent surgery was significantly better than that of the 286 patients without surgery (31 vs. 15 months, p<0.001). The OS for the R0 or R1 resection group was significantly longer than that for the R2 or non-surgery group, as well as for n0 compared to n1 (all p<0.001). Chemoradiotherapy (CRT), both sequential and concurrent, resulted in a better OS than RT alone for the n1 group (31 vs. 13 months, p<0.001), and marginally better for the R0/R1 group (p=0.065; p=0.054 for concurrent CRT). However, no such benefit was observed for the R2/non-surgical patients. Multivariate analysis identified performance status, clinical stage, and surgery as significant factors. CONCLUSION: Surgery, especially R0/R1 resection, seemed as the gold standard for treatment of biliary tract cancer including RT, even in the highly heterogeneous population obtained from the multicenter retrospective study. The possibility was shown that CRT yielded better survival benefit especially for n1 patients. We recommend that future prospective trials include an arm of adjuvant CRT at least for n1 and possibly R0/R1 patients.
Authors: Edward Christopher Dee; Morgan E Freret; Nora Horick; Ann C Raldow; Lipika Goyal; Andrew X Zhu; Aparna R Parikh; David P Ryan; Jeffrey W Clark; Jill N Allen; Cristina R Ferrone; Carlos Fernandez-Del Castillo; Kenneth K Tanabe; Lorraine C Drapek; Theodore S Hong; Motaz Qadan; Jennifer Y Wo Journal: Ann Surg Oncol Date: 2020-08-01 Impact factor: 5.344