Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Postoperative radiotherapy dose correlates with locoregional control in patients with extra-hepatic bile duct cancer

  • Im, Jung Ho (Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine) ;
  • Seong, Jinsil (Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Jeongshim (Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Yong Bae (Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Ik Jae (Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Jun Sung (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon, Dong Sup (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Kyung Sik (Department of Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Woo Jung (Department of Surgery, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2013.12.28
  • Accepted : 2014.02.13
  • Published : 2014.03.31
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Abstract

Purpose: To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. Materials and Methods: Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). Results: The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (${\geq}50$ Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). Conclusion: In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.

Keywords

References

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