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. 2023 May 4;30(5):4754-4766.
doi: 10.3390/curroncol30050358.

The Potential Role of Adjuvant Chemoradiotherapy in Patients with Microscopically Positive (R1) Surgical Margins after Resection of Cholangiocarcinoma

Andrea Palloni  1 , Silvia Bisello  2 , Ilaria Maggio  3 , Maria Massucci  1 , Andrea Galuppi  2 , Alessandro Di Federico  1   4 , Alessandro Rizzo  5 , Angela Dalia Ricci  6 , Giambattista Siepe  2 , Alessio Giuseppe Morganti  2 , Giovanni Brandi  1   4 , Giorgio Frega  7
Affiliations

The Potential Role of Adjuvant Chemoradiotherapy in Patients with Microscopically Positive (R1) Surgical Margins after Resection of Cholangiocarcinoma

Andrea Palloni et al. Curr Oncol. .

Abstract

(1) Background: Biliary tract cancers (BTCs) are a heterogeneous group of neoplasms with dismal prognosis and the role of adjuvant chemoradiotherapy in high-risk resected patients is unclear. (2) Methods: We retrospectively analyzed the outcomes of BTC patients who received curative intent surgery with microscopically positive resection margins (R1) and adjuvant chemoradioradiotherapy (CCRT) or chemotherapy (CHT) from January 2001 to December 201. (3) Results: Out of 65 patients who underwent R1 resection, 26 received adjuvant CHT and 39 adjuvant CCRT. The median recurrence-free survival (RFS) in the CHT and CHRT groups was 13.2 and 26.8 months, respectively (p = 0.41). Median overall survival (OS) was higher in the CHRT group (41.9 months) as compared to the CHT group (32.2 months), but the difference was not statistically significant (HR 0.88; p = 0.7). A promising trend in favor of CHRT was observed in N0 patients. Finally, no statistically significant differences were observed between patients undergoing adjuvant CHRT after R1 resection and patients treated with chemotherapy alone after R0 surgery. (4) Conclusions: Our study did not show a significant survival benefit with adjuvant CHRT over CHT alone in BTC patients with positive resection margins, while a promising trend was observed.

Keywords: R1 surgery; biliary tract cancers; chemo-radiotherapy; cholangiocarcinoma; radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Kaplan–Meier curves comparing different adjuvant strategies after upfront surgery. (a) Recurrence-free survival of patients treated with chemotherapy alone or combined chemoradiotherapy. (b) Overall survival of patients treated with chemotherapy alone or combined chemoradiotherapy.
Figure 3
Figure 3
Kaplan–Meier curves comparing different adjuvant strategies after upfront surgery in patients without nodal involvement (N0). (a) Recurrence-free survival of N0 patients treated with chemotherapy alone or combined chemoradiotherapy. (b) Overall survival of N0 patients treated with chemotherapy alone or combined chemoradiotherapy. (c) Recurrence-free survival of patients treated with combined chemoradiotherapy after R1 resection compared with an independent retrospective cohort of patients (n = 91) who received only CTX after R0 surgery. (d) Overall survival of patients treated with combined chemoradiotherapy after R1 resection compared with an independent retrospective cohort of patients (n = 91) who received only CTX after R0 surgery.
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