- 作者：Jin-hong Park M.D.* ; Eun Kyung Choi M.D. ; Ph.D.* ; Seung Do Ahn M.D. ; Ph.D.* ; Sang-wook Lee M.D. ; Ph.D.* ; Si Yeol Song M.D. ; Ph.D.* ; Sang Min Yoon M.D. ; Ph.D.* ; Young Seok Kim M.D.* ; Yu Sun Lee M.D.* ; Sung-Gyu Lee M.D. ; Ph.D.† ; ; Shin Hwang M.D. ; Ph.D.† ; ; Young-Joo Lee M.D. ; Ph.D.† ; ; Kwang-Min Park M.D. ; Ph.D.† ; ; Tae Won Kim M.D. ; Ph.D.‡ ; ; Heung Moon Chang M.D. ; Ph.D.‡ ; ; Jae-Lyun Lee M.D. ; Ph.D.‡ ; ; Jong Hoon Kim M.D. ; Ph.D.* ; jhkim2@amc.seoul.kr
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2011
- 出版时间：1 March 2011
- 年：2011
- 卷：79
- 期：3
- 页码：696-704
- 全文大小：209 K
Purpose
To evaluate the effect of postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy and to identify the prognostic factors that influence survival in patients with extrahepatic bile duct cancer.Methods and Materials
We retrospectively analyzed the data from 101 patients with extrahepatic bile duct cancer who had undergone postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy. Of the 101 patients, 52 (51 % ) had undergone complete resection (R0 resection) and 49 (49 % ) had microscopic or macroscopic residual tumors (R1 or R2 resection). The median radiation dose was 50 Gy. Also, 85 patients (84 % ) underwent concurrent chemotherapy with 5-fluorouracil.
Results
The median follow-up period was 47 months for the surviving patients. The 5-year overall survival rate was 34 % for all patients. A comparison between patients with R0 and R1 resection indicated no significant difference in the 5-year overall survival (44 % vs. 33 % , p = .2779), progression-free survival (35 % vs. 22 % , p = .3107), or locoregional progression-free survival (75 % vs. 63 % , p = .2784) rates. An analysis of the first failure site in the 89 patients with R0 or R1 resection indicated isolated locoregional recurrence in 7 patients. Elevated postoperative carbohydrate antigen 19-9 level was an independent prognostic factor for overall survival (p = .001) and progression-free survival (p = .033). A total of 3 patients developed Grade 3 or greater late toxicity.
Conclusion
Adjuvant concurrent chemoradiotherapy using three-dimensional conformal radiotherapy appears to improve locoregional control and survival in extrahepatic bile duct cancer patients with R1 resection. The postoperative carbohydrate antigen 19-9 level might be a useful prognostic marker to select patients for more intensified adjuvant therapy.