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. 2025 Feb 2;17(3):494.
doi: 10.3390/cancers17030494.

Defining the Role of Adjuvant Radiotherapy for Biliary Tract Cancers: A Site-Specific Propensity-Matched Analysis

Yongwoo David Seo  1 , Belkacem Acidi  1 , Andrew Newton  2 , Antony Haddad  1 , Yi-Ju Chiang  1 , Rainna Coelho  3 , Timothy E Newhook  1 , Ching-Wei D Tzeng  1 , Yun Shin Chun  1 , Ethan B Ludmir  4 , Eugene J Koay  4 , Milind Javle  5 , Jean Nicolas Vauthey  1 , Hop S Tran Cao  1
Affiliations

Defining the Role of Adjuvant Radiotherapy for Biliary Tract Cancers: A Site-Specific Propensity-Matched Analysis

Yongwoo David Seo et al. Cancers (Basel). .

Abstract

Background: Biliary tract cancers (BTCs) have distinct tumor biology but share a poor prognosis, with a 5-year-survival-rate of 5-19%. Surgical resection is the only potential cure, but recurrences are common. The role of adjuvant radiotherapy (XRT) remains unclear. Methods: Using the National Cancer Database (2006-2018), we analyzed resected non-metastatic BTCs. Patients who survived beyond 90 days post-surgery were included, while those with R2 resections or neoadjuvant therapy were excluded. Propensity matching was performed based on predictors of adjuvant radiation, age, and sex. Survival outcomes were compared between no adjuvant therapy, chemotherapy alone, and XRT ± chemotherapy. Results: Among 21,275 patients, including 5308 intrahepatic cholangiocarcinoma (IHC), 2689 perihilar cholangiocarcinoma (PHC), 3092 distal cholangiocarcinoma (DCC), and 10,186 gallbladder cancer (GBC) cases, adjuvant XRT did not improve survival for IHC. For PHC and DCC, XRT improved survival over no adjuvant therapy (PHC: 31.2 vs. 26.3 months, p = 0.004; DCC: 33.7 vs. 27.0 months, p = 0.015) but not over chemotherapy alone. For GBC, XRT significantly improved survival compared to both no adjuvant therapy and chemotherapy (30.2 vs. 26.6 and 24.6 months; p = 0.05 and p = 0.001). Conclusions: XRT provides a survival benefit for GBC, especially in node-positive and R1-resected patients. For PHC and DCC, XRT improves outcomes compared to no therapy, but its benefit over chemotherapy is uncertain. No benefit was observed for IHC.

Keywords: adjuvant therapy; biliary tract cancer; chemoradiotherapy; liver cancer.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram and population distribution. NCDB: National Cancer Database; GBC: gallbladder cancer; ECCA: extrahepatic cholangiocarcinoma; ICCA: intrahepatic cholangiocarcinoma; POD: post-operative days. Chemo: chemotherapy; XRT: chemo(radiation) therapy.
Figure 2
Figure 2
Sensitivity analysis of propensity-matched cohorts using Cox proportional hazards model.
See this image and copyright information in PMC

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