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Patterns of Failure and the Need for Biliary Intervention in Resected Biliary Tract Cancers After Chemoradiation

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study assessed patterns of failure and rates of subsequent biliary intervention among patients with resected biliary tract cancers (BTCs) including gallbladder carcinoma (GBC) and extra- and intrahepatic cholangiocarcinoma (eCCA and iCCA) treated with adjuvant chemoradiation therapy (CRT).

Methods

In this single-institution retrospective analysis of 80 patients who had GBC (n = 29), eCCA (n = 43), or iCCA (n = 8) treated with curative-intent resection and adjuvant CRT from 2007 to 2017, the median radiation dose was 50.4 Gy (range 36–65 Gy) with concurrent 5-fluorouracil (5-FU) chemotherapy. All but two of the patients received adjuvant chemotherapy. The 2-year locoregional failure (LRF), 2-year recurrence-free survival (RFS), and 2-year overall survival (OS), and univariate predictors of LRF, RFS, and OS were calculated for the entire cohort and for a subgroup excluding patients with iCCA (n = 72). The predictors of biliary interventions also were assessed.

Results

Of the 80 patients (median follow-up period, 30.5 months; median OS, 33.9 months), 54.4% had American Joint Committee on Cancer (AJCC) stage 1 or 2 disease, 57.1% were lymph node-positive, and 66.3% underwent margin-negative resection. For the entire cohort, 2-year LRF was 23.8%, 2-year RFS was  43.7%, and 2-year OS was 62.1%.  When patients with iCCA were excluded, the 2-year LRF was 22.6%, the 2-year RFS was 43.9%, and the 2-year OS was 59.2%. In the overall and subgroup univariate analyses, lymph node positivity was associated with greater LRF, whereas resection margin was not. Biliary intervention was required for 12 (63.2%) of the 19 patients with LRF versus 11 (18%) of the 61 patients without LRF (P < 0.001). Of the 12 patients with LRF who required biliary intervention, 4 died of biliary complications.

Conclusions

The LRF rates remained significant despite adjuvant CRT. Lymph node positivity may be associated with increased risk of LRF. Positive margins were not associated with greater LRF, suggesting that CRT may mitigate LRF risk for this group. An association between LRF and higher rates of subsequent biliary interventions was observed, which may yield significant morbidity. Novel strategies to decrease the rates of LRF should be considered.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Edward Christopher Dee BS

  2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Morgan E. Freret MD, PhD

  3. Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

    Nora Horick MS

  4. Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA

    Ann C. Raldow MD, MPH

  5. Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Lipika Goyal MD, MPhil, Andrew X. Zhu MD, PhD, Aparna R. Parikh MD, David P. Ryan MD, Jeffrey W. Clark MD & Jill N. Allen MD

  6. Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Cristina R. Ferrone MD, Carlos Fernandez-del Castillo MD & Motaz Qadan MD, PhD

  7. Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Kenneth K. Tanabe MD

  8. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Lorraine C. Drapek DNP, Theodore S. Hong MD & Jennifer Y. Wo MD

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Dee, E.C., Freret, M.E., Horick, N. et al. Patterns of Failure and the Need for Biliary Intervention in Resected Biliary Tract Cancers After Chemoradiation. Ann Surg Oncol 27, 5161–5172 (2020). https://doi.org/10.1245/s10434-020-08967-9

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