BACKGROUND: Adjuvant (chemo)radiotherapy (A(C)RT) may be an important supplement to surgery for extrahepatic cholangiocarcinoma (EHCC). However, whether all patients would achieve benefits from A(C)RT and which adjuvant regimen, adjuvant radiotherapy (ART) or adjuvant chemoradiotherapy (ACRT), would be preferred, are still undetermined. The low incidence of EHCC makes it difficult to carry out randomized controlled trials (RCTs); therefore, almost all clinical studies on radiotherapy are retrospective. We have conducted a meta-analysis of these retrospective studies. METHODS: We conducted a meta-analysis of current retrospective studies using PubMed, Embase, and ClinicalTrials databases. All studies published in English that were related to A(C)RT and which analyzed overall survival (OS), disease-free survival (DFS), or locoregional recurrence-free survival (LRFS) were included. Estimated hazard ratios (HRs) were calculated for OS, DFS, and LRFS. RESULTS: Data from eight studies including 685 patients were included. Our analysis showed that A(C)RT significantly improved OS (HR 0.69, 95% confidence interval (CI) 0.48-0.97, P=0.03), DFS (HR 0.60, 95% CI 0.47-0.76, P<0.0001), and LRFS (HR 0.27, 95% CI 0.17-0.41, P<0.00001) of EHCC overall. In subgroups, patients with microscopically positive resection margin (R1) could achieve a benefit from A(C)RT (HR 0.44, 95% CI 0.27-0.72, P=0.001). No statistically OS difference was observed in negative resection margin (R0) subgroup (HR 0.98, 95% CI 0.30-3.19, P=0.98).Significant OS benefit was found in patients who received concurrent ACRT (HR 0.40, 95% CI 0.26-0.62, P<0.0001), while the result of ART without chemotherapy showed no significant benefit (HR 1.14, 95% CI 0.29-4.50, P=0.85). In the distal cholangiocarcinoma subgroup, no significant difference was seen when ACRT and ART were included (HR 0.61, 95% CI 0.14-2.72, P=0.52), but a significant difference was seen when analyzing the concurrent ACRT only (HR 0.29, 95% CI 0.13-0.64, P=0.002). CONCLUSIONS: A(C)RT may improve OS, DFS, and LRFS in EHCC patients, especially in those with R1 resection margins. ACRT may be superior to ART especially in distal patients.
BACKGROUND: Adjuvant (chemo)radiotherapy (A(C)RT) may be an important supplement to surgery for extrahepatic cholangiocarcinoma (EHCC). However, whether all patients would achieve benefits from A(C)RT and which adjuvant regimen, adjuvant radiotherapy (ART) or adjuvant chemoradiotherapy (ACRT), would be preferred, are still undetermined. The low incidence of EHCC makes it difficult to carry out randomized controlled trials (RCTs); therefore, almost all clinical studies on radiotherapy are retrospective. We have conducted a meta-analysis of these retrospective studies. METHODS: We conducted a meta-analysis of current retrospective studies using PubMed, Embase, and ClinicalTrials databases. All studies published in English that were related to A(C)RT and which analyzed overall survival (OS), disease-free survival (DFS), or locoregional recurrence-free survival (LRFS) were included. Estimated hazard ratios (HRs) were calculated for OS, DFS, and LRFS. RESULTS: Data from eight studies including 685 patients were included. Our analysis showed that A(C)RT significantly improved OS (HR 0.69, 95% confidence interval (CI) 0.48-0.97, P=0.03), DFS (HR 0.60, 95% CI 0.47-0.76, P<0.0001), and LRFS (HR 0.27, 95% CI 0.17-0.41, P<0.00001) of EHCC overall. In subgroups, patients with microscopically positive resection margin (R1) could achieve a benefit from A(C)RT (HR 0.44, 95% CI 0.27-0.72, P=0.001). No statistically OS difference was observed in negative resection margin (R0) subgroup (HR 0.98, 95% CI 0.30-3.19, P=0.98).Significant OS benefit was found in patients who received concurrent ACRT (HR 0.40, 95% CI 0.26-0.62, P<0.0001), while the result of ART without chemotherapy showed no significant benefit (HR 1.14, 95% CI 0.29-4.50, P=0.85). In the distal cholangiocarcinoma subgroup, no significant difference was seen when ACRT and ART were included (HR 0.61, 95% CI 0.14-2.72, P=0.52), but a significant difference was seen when analyzing the concurrent ACRT only (HR 0.29, 95% CI 0.13-0.64, P=0.002). CONCLUSIONS:A(C)RT may improve OS, DFS, and LRFS in EHCC patients, especially in those with R1 resection margins. ACRT may be superior to ART especially in distal patients.
Authors: Tamara Z Vern-Gross; Anand T Shivnani; Ke Chen; Christopher M Lee; Jonathan D Tward; O Kenneth MacDonald; Christopher H Crane; Mark S Talamonti; Louis L Munoz; William Small Journal: Int J Radiat Oncol Biol Phys Date: 2010-10-23 Impact factor: 7.038
Authors: Jeong Il Yu; DO Hoon Lim; Jeeyun Lee; Won Ki Kang; Se Hoon Park; Joon Oh Park; Ho Yeong Lim; Seung Tae Kim; Sung Kim; Tae Sung Sohn; Jun Ho Lee; Ji Yeong An; Min Gew Choi; Jae Moon Bae; Hye Seung Kim; Soohyun Ahn Journal: Anticancer Res Date: 2019-10 Impact factor: 2.480
Authors: A Nakeeb; H A Pitt; T A Sohn; J Coleman; R A Abrams; S Piantadosi; R H Hruban; K D Lillemoe; C J Yeo; J L Cameron Journal: Ann Surg Date: 1996-10 Impact factor: 12.969
Authors: Ji Eun Yoon; Soo Young Lee; Han Duk Kwak; Seung Seop Yeom; Chang Hyun Kim; Jae Kyun Joo; Hyeong Rok Kim; Young Jin Kim Journal: Ann Coloproctol Date: 2019-06-30
Authors: Shahid A Khan; Brian R Davidson; Robert D Goldin; Nigel Heaton; John Karani; Stephen P Pereira; William M C Rosenberg; Paul Tait; Simon D Taylor-Robinson; Andrew V Thillainayagam; Howard C Thomas; Harpreet Wasan Journal: Gut Date: 2012-08-15 Impact factor: 23.059
Authors: Seo Hee Choi; Chai Hong Rim; In-Soo Shin; Won Sup Yoon; Woong Sub Koom; Jinsil Seong Journal: Liver Cancer Date: 2021-08-26 Impact factor: 11.740