Abstract
Purpose
This study aims to evaluate survival and the objective response to neoadjuvant combination
therapy with gemcitabine and radiation therapy in patients with biliary tract cancer.
Methods
The chemoradiation therapy regimen consisted of 3 cycles of full-dose gemcitabine
(1000 mg/m2 at days 1, 8, and 15, every 4 weeks) with 50–60 Gy radiation. We compared 27 patients
who received neoadjuvant chemoradiation therapy and 79 patients who were treated without
neoadjuvant therapy. Hemi-hepatectomy or pancreatoduodenectomy was planned for all
of the patients in the study population. CT-based staging was used to adjust for the
pre-treatment characteristics of the patients.
Results
After confirming the reproducibility of CT-based staging, we analyzed the survival
of the patients. The multivariate analysis showed that the absence of arterial invasion
on CT, the absence of lymph node swelling, and neoadjuvant therapy were independent
prognostic factors. The three-year recurrence-free survival (RFS) rates in patients
treated with and without neoadjuvant therapy were 78% and 58%, respectively (P = 0.0263). The adjusted overall survival (OS) (determined by the inverse probability
of treatment weighting method using the inverse propensity score) was improved by
neoadjuvant therapy (P = 0.00187); the hazard ratio was 0.3505.
Conclusions
Neoadjuvant chemoradiation therapy might have the potential to improve RFS and OS.
Registration
UMIN-CTR UMIN000015450
Keywords
Abbreviations:
BTC (biliary tract cancer), CA19-9 (carbohydrate antigen 19-9), CEA (carcinoembryonic antigen), IPTW (inverse probability of treatment weighting), OS (overall survival), PVE (portal vein embolization), RFS (recurrence free survival), UICC (International Union Against Cancer)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 13, 2017
Accepted:
December 16,
2016
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
