Skip Navigation LinksHome > August 2015 - Volume 38 - Issue 4 > Outcome of Adjuvant Therapy in Biliary Tract Cancers
American Journal of Clinical Oncology:
doi: 10.1097/COC.0b013e31829e19fb
Original Articles: Gastrointestinal

Outcome of Adjuvant Therapy in Biliary Tract Cancers

McNamara, Mairead G. MB, PhD*; Walter, Thomas MD*,†; Horgan, Anne M. MB*,‡; Amir, Eitan MB, PhD*; Cleary, Sean MD§; McKeever, Elizabeth L.*; Min, Trisha*; Wallace, Elaine MB; Hedley, David MD, PhD*; Krzyzanowska, Monika MD*; Moore, Malcolm MD*; Gallinger, Steven MD§; Greig, Paul MD§; Serra, Stefano MD; Dawson, Laura A. MD#; Knox, Jennifer J. MD*

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Objective: There are high rates of recurrence after definitive surgery in biliary tract cancer patients. We reviewed the use and effectiveness of adjuvant therapy (AT; chemotherapy±radiotherapy) in a single institution series.

Methods: Characteristics, treatment details, and follow-up data of all patients with biliary tract cancer who had definitive surgery from January 1987 to September 2011 were reviewed. The association between baseline variables and disease-free survival/overall survival (OS) were tested using Cox proportional hazard analysis in the univariable and multivariable settings.

Results: Analysis included 296 patients (58% male; median age, 63 y). Negative or microscopically positive resections were reported in 42% and 14%, respectively, with 44% not reported. Node positivity was reported in 35% patients. AT was given in 28% of patients with 59% receiving chemotherapy and 35% concurrent chemotherapy/radiotherapy. Disease recurred in 60% patients. AT was associated with significantly improved OS (hazard ratio, 0.41; P=0.02). Compared with R0 resection, patients with R1 resection derived significantly increased benefit from AT (P for difference 0.02). In the node positive population (n=103), AT was associated with significantly improved OS (hazard ratio, 0.60; 95% confidence interval, 0.38-0.95; P=0.03).

Conclusions: Patients with R1 resection and node positive disease receiving AT after definitive surgery seem to derive OS advantage. Large prospective trials are needed to confirm these data.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


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