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R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer.

ABSTRACT: There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n = 237, gallbladder cancer n = 84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors.Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival.In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.

SUBMITTER: Matull WR

PROVIDER: S-EPMC2997861 | biostudies-literature | 2011 Jan

REPOSITORIES: biostudies-literature

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R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer.

Matull Wolf-Rudiger WR Dhar Dipok K DK Ayaru Lakshmana L Sandanayake Neomal S NS Chapman Michael H MH Dias Aruna A Bridgewater John J Webster George J M GJ Bong Jin J JJ Davidson Brian R BR Pereira Stephen P SP

Liver international : official journal of the International Association for the Study of the Liver 20100916 1

<h4>Background</h4>There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).<h4>Aim</h4>To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.<h4>Method</h4>We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n = 237, gallbladder cancer n = 84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease sta ...[more]

PMID: 20846273

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Project description:The purpose of radiation therapy for unresectable biliary tract cancer is to prolong survival or prolong stent patency, and to provide palliation of pain. For unresectable bile duct cancer, there are a number of studies showing that radiation therapy is superior to the best supportive care. Although radiation therapy is used in many institutions, no large randomized controlled trials (RCTs) have been performed to date and the evidence level supporting the superiority of this treatment is low. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiation therapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. There are many reports demonstrating improved response rates as well as extended survival and time to recurrence achieved by this combination therapy. Despite the low level of the evidence, this combination therapy is performed at many institutions. It is expected that multi-institutional RCTs will be carried out. Unresectable gallbladder cancer with a large focus is usually extensive, and normal organs with high radio sensitivity exist contiguously with it. Therefore, only limited anticancer effects are to be expected from external beam radiation therapy for this type of cancer. The number of reports on ampullary cancer is small and the role of radiation therapy in this cancer has not been established. Combination treatment for ampullary cancer consists of either a single use of intraoperative radiation therapy, postoperative external beam radiation therapy or intraluminal brachytherapy, or a combination of two or three of these therapies. Intraoperative radiation therapy is superior in that it enables precise irradiation to the target site, thereby protecting adjacent highly radiosensitive normal tissues from irradiation. There are reports showing extended survival, although not significant, in groups undergoing intraoperative or postoperative radiation therapy compared with groups without radiation therapy. To date, there are no reports of large RCTs focusing on the significance of radiation therapy as a postoperative adjuvant treatment, so its usefulness as a postoperative adjuvant treatment is not proven. An alternative treatment is photodynamic therapy. There is an RCT demonstrating that, in unresectable bile duct cancer, extended survival and improved quality of life (QOL) have been achieved through a combination of photodynamic therapy and biliary stenting, compared with biliary stenting alone. Results from large RCTs are desired.

Dataset Information

R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer.

Publications

R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer.

Similar Datasets

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