Treatment Outcome of Postoperative Radiotherapy in Extrahepatic Bile Duct Cancer

Choi, Youngmin; Cho, Heunglae

Abstract

PURPOSE: To evaluate the efficacy of radiotherapy, and the factors affecting survival in patients of extrahepatic bile duct cancer, by analyzing the results of postoperative radiotherapy.
MATERIALS AND METHODS
Between October 1991 and July 2001, 21 patients with extrahepatic bile duct cancer, who received radiotherapy after a radical resection, were retrospectively reviewed. The patients' ages ranged from 39 to 75 years, with a median of 61 years, and a male to female ratio of 16 to 5. The numbers of patients with proximal and distal bile duct cancer were 14 and 7, respectively. From the postoperative pathological examination, 19 of the patients were found to have microscopic residues, and 7 to be lymph node positive. Patients with AJCC stages I, II and III were 10, 10 and 1, respectively. The total radiation dose administered was 4,500~6,300 cGy, with a median dose of 5,040 cGy. The follow up period was 20~81 months, with a median of 57.5 months.
RESULTS
The overall and disease free survival rates at 3 and 5 years were 41.0 and 29.3%, and 41.6 and 29.7%, respectively. The influences of age, sex, tumor location, differentiation, microscopic residue, neural invasion, T and N stage, the stage itself, the dose of radiation and chemotherapy, on survival were evaluated. The T stage and the stage itself were found to be significant from a univariate analysis (p< 0.05), but the degree of significance was limited by the small number of patients. A recurrence occurred in 12 patients (57.1%), 5 in locoregional sites, 4 in distant sites and 3 in a combination of locoregional and distant sites, and the sites of distant metastasis were the liver, 6, and the bone, 1. Grade 2 or 3 acute leucopenias occurred in 2 patients and grade 2 chronic peptic ulcers occurred in 4, who were all recovered by conservative management.
CONCLUSION
Postoperative radiotherapy is feasible in extrahepatic bile duct cancer, with tolerable toxicity, but prospective studies, with a large patient enrollment, are needed for the evaluation of the effects of postoperative radiotherapy and the related prognostic factors.