Radiation therapy for extrahepatic bile duct cancer: Current evidences and future perspectives
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摘要
Extrahepatic bile duct cancer(EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct.The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit.Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy.The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC.
Extrahepatic bile duct cancer(EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct.The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit.Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy.The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC.
Extrahepatic bile duct cancer(EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct.The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit.Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy.The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC.
引文
1 Khan SA,Thomas HC,Davidson BR,Taylor-Robinson SD.Cholangiocarcinoma.Lancet 2005;366:1303-1314[PMID:16214602 DOI:10.1016/S0140-6736(05)67530-7]
2 Jarnagin WR,Fong Y,DeMatteo RP,Gonen M,Burke EC,Bodniewicz BS J,Youssef BA M,Klimstra D,Blumgart LH.Staging,resectability,and outcome in 225 patients with hilar cholangiocarcinoma.Ann Surg 2001;234:507-517;discussion 517-519[PMID:11573044]
3 Kosuge T,Yamamoto J,Shimada K,Yamasaki S,Makuuchi M.Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection.Ann Surg 1999;230:663-671[PMID:10561090]
4 Wakai T,Shirai Y,Moroda T,Yokoyama N,Hatakeyama K.Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma.Cancer 2005;103:1210-1216[PMID:15685618 DOI:10.1002/cncr.20906]
5 Jang JY,Kim SW,Park DJ,Ahn YJ,Yoon YS,Choi MG,Suh KS,Lee KU,Park YH.Actual long-term outcome of extrahepatic bile duct cancer after surgical resection.Ann Surg 2005;241:77-84[PMID:15621994]
6 Hemming AW,Reed AI,Fujita S,Foley DP,Howard RJ.Surgical management of hilar cholangiocarcinoma.Ann Surg 2005;241:693-699;discussion 699-702[PMID:15849505]
7 Ebata T,Hirano S,Konishi M,Uesaka K,Tsuchiya Y,Ohtsuka M,Kaneoka Y,Yamamoto M,Ambo Y,Shimizu Y,Ozawa F,Fukutomi A,Ando M,Nimura Y,Nagino M;Bile Duct Cancer Adjuvant Trial(BCAT)Study Group.Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer.Br J Surg 2018;105:192-202[PMID:29405274 DOI:10.1002/bjs.10776]
8 Edeline J,Benabdelghani M,Bertaut A,Watelet J,Hammel P,Joly JP,Boudjema K,Fartoux L,BouhierLeporrier K,Jouve JL,Faroux R,Guerin-Meyer V,Kurtz JE,Assénat E,Seitz JF,Baumgaertner I,Tougeron D,de la Fouchardière C,Lombard-Bohas C,Boucher E,Stanbury T,Louvet C,Malka D,Phelip JM.Gemcitabine and Oxaliplatin Chemotherapy or Surveillance in Resected Biliary Tract Cancer(PRODIGE 12-ACCORD 18-UNICANCER GI):A Randomized Phase III Study.J Clin Oncol 2019;37:658-667[PMID:30707660 DOI:10.1200/JCO.18.00050]
9 Valle J,Wasan H,Palmer DH,Cunningham D,Anthoney A,Maraveyas A,Madhusudan S,Iveson T,Hughes S,Pereira SP,Roughton M,Bridgewater J;ABC-02 Trial Investigators.Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.N Engl J Med 2010;362:1273-1281[PMID:20375404 DOI:10.1056/NEJMoa0908721]
10 Choi HS,Kang KM,Jeong BK,Jeong H,Lee YH,Ha IB,Kim TG,Song JH.Patterns of failure after resection of extrahepatic bile duct cancer:implications for adjuvant radiotherapy indication and treatment volumes.Radiat Oncol 2018;13:85[PMID:29739420 DOI:10.1186/s13014-018-1024-z]
11 Koo TR,Eom KY,Kim IA,Cho JY,Yoon YS,Hwang DW,Han HS,Kim JS.Patterns of failure and prognostic factors in resected extrahepatic bile duct cancer:implication for adjuvant radiotherapy.Radiat Oncol J 2014;32:63-69[PMID:25061574 DOI:10.3857/roj.2014.32.2.63]
12 Jarnagin WR,Ruo L,Little SA,Klimstra D,D'Angelica M,DeMatteo RP,Wagman R,Blumgart LH,Fong Y.Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma:implications for adjuvant therapeutic strategies.Cancer 2003;98:1689-1700[PMID:14534886 DOI:10.1002/cncr.11699]
13 Sakamoto E,Nimura Y,Hayakawa N,Kamiya J,Kondo S,Nagino M,Kanai M,Miyachi M,Uesaka K.The pattern of infiltration at the proximal border of hilar bile duct carcinoma:a histologic analysis of 62resected cases.Ann Surg 1998;227:405-411[PMID:9527064]
14 Burke EC,Jarnagin WR,Hochwald SN,Pisters PW,Fong Y,Blumgart LH.Hilar Cholangiocarcinoma:patterns of spread,the importance of hepatic resection for curative operation,and a presurgical clinical staging system.Ann Surg 1998;228:385-394[PMID:9742921]
15 Sakamoto Y,Kosuge T,Shimada K,Sano T,Ojima H,Yamamoto J,Yamasaki S,Takayama T,Makuuchi M.Prognostic factors of surgical resection in middle and distal bile duct cancer:an analysis of 55 patients concerning the significance of ductal and radial margins.Surgery 2005;137:396-402[PMID:15800484DOI:10.1016/j.surg.2004.10.008]
16 Kim K,Chie EK,Jang JY,Kim SW,Han SW,Oh DY,Im SA,Kim TY,Bang YJ,Ha SW.Adjuvant chemoradiotherapy after curative resection for extrahepatic bile duct cancer:a long-term single center experience.Am J Clin Oncol 2012;35:136-140[PMID:21325937 DOI:10.1097/COC.0b013e318209aa29]
17 Park JH,Choi EK,Ahn SD,Lee SW,Song SY,Yoon SM,Kim YS,Lee YS,Lee SG,Hwang S,Lee YJ,Park KM,Kim TW,Chang HM,Lee JL,Kim JH.Postoperative chemoradiotherapy for extrahepatic bile duct cancer.Int J Radiat Oncol Biol Phys 2011;79:696-704[PMID:20510541 DOI:10.1016/j.ijrobp.2009.12.031]
18 Nelson JW,Ghafoori AP,Willett CG,Tyler DS,Pappas TN,Clary BM,Hurwitz HI,Bendell JC,Morse MA,Clough RW,Czito BG.Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma.Int J Radiat Oncol Biol Phys 2009;73:148-153[PMID:18805651 DOI:10.1016/j.ijrobp.2008.07.008]
19 Ben-David MA,Griffith KA,Abu-Isa E,Lawrence TS,Knol J,Zalupski M,Ben-Josef E.External-beam radiotherapy for localized extrahepatic cholangiocarcinoma.Int J Radiat Oncol Biol Phys 2006;66:772-779[PMID:17011452 DOI:10.1016/j.ijrobp.2006.05.061]
20 Oh D,Lim DH,Heo JS,Choi SH,Choi DW,Ahn YC,Park W,Huh SJ.The role of adjuvant radiotherapy in microscopic tumor control after extrahepatic bile duct cancer surgery.Am J Clin Oncol 2007;30:21-25[PMID:17278890 DOI:10.1097/01.coc.0000245467.97180.78]
21 Ben-Josef E,Guthrie KA,El-Khoueiry AB,Corless CL,Zalupski MM,Lowy AM,Thomas CR,Alberts SR,Dawson LA,Micetich KC,Thomas MB,Siegel AB,Blanke CD.SWOG S0809:A Phase II Intergroup Trial of Adjuvant Capecitabine and Gemcitabine Followed by Radiotherapy and Concurrent Capecitabine in Extrahepatic Cholangiocarcinoma and Gallbladder Carcinoma.J Clin Oncol 2015;33:2617-2622[PMID:25964250 DOI:10.1200/JCO.2014.60.2219]
22 Pitt HA,Nakeeb A,Abrams RA,Coleman J,Piantadosi S,Yeo CJ,Lillemore KD,Cameron JL.Perihilar cholangiocarcinoma.Postoperative radiotherapy does not improve survival.Ann Surg 1995;221:788-97;discussion 797-8[PMID:7794082]
23 Vern-Gross TZ,Shivnani AT,Chen K,Lee CM,Tward JD,MacDonald OK,Crane CH,Talamonti MS,Munoz LL,Small W.Survival outcomes in resected extrahepatic cholangiocarcinoma:effect of adjuvant radiotherapy in a surveillance,epidemiology,and end results analysis.Int J Radiat Oncol Biol Phys 2011;81:189-198[PMID:20971573 DOI:10.1016/j.ijrobp.2010.05.001]
24 Yu JB,Decker RH,Knisely JP.The role of postoperative radiation therapy(PORT)in the treatment of extrahepatic bile duct cancer:a surveillance,epidemiology,and end results(SEER)population-based investigation.J Gastrointest Cancer 2008;39:11-21[PMID:19156542 DOI:10.1007/s12029-008-9045-8]
25 Hoehn RS,Wima K,Ertel AE,Meier A,Ahmad SA,Shah SA,Abbott DE.Adjuvant Chemotherapy and Radiation Therapy is Associated with Improved Survival for Patients with Extrahepatic Cholangiocarcinoma.Ann Surg Oncol 2015;22 Suppl 3:S1133-S1139[PMID:25976862 DOI:10.1245/s10434-015-4599-8]
26 Ecker BL,Vining CC,Roses RE,Maggino L,Lee MK,Drebin JA,Fraker DL,Vollmer CM,Datta J.Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of the Extrahepatic Bile Ducts:A Propensity Score-Matched Analysis.Ann Surg Oncol 2017;24:3926-3933[PMID:28952140DOI:10.1245/s10434-017-6095-9]
27 Krasnick BA,Jin LX,Davidson JT 4th,Sanford DE,Ethun CG,Pawlik TM,Poultsides GA,Tran T,Idrees K,Hawkins WG,Chapman WC,Doyle MBM,Weber SM,Strasberg SM,Salem A,Martin RCG,Isom CA,Scoggins C,Schmidt CR,Shen P,Beal E,Hatzaras I,Shenoy R,Maithel SK,Fields RC.Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma:A multi-institution analysis from the U.S.extrahepatic biliary malignancy consortium.J Surg Oncol 2018;117:363-371[PMID:29284072 DOI:10.1002/jso.24836]
28 Todoroki T,Ohara K,Kawamoto T,Koike N,Yoshida S,Kashiwagi H,Otsuka M,Fukao K.Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma.Int J Radiat Oncol Biol Phys 2000;46:581-587[PMID:10701737]
29 Heron DE,Stein DE,Eschelman DJ,Topham AK,Waterman FM,Rosato EL,Alden M,Anne PR.Cholangiocarcinoma:the impact of tumor location and treatment strategy on outcome.Am J Clin Oncol2003;26:422-428[PMID:12902899 DOI:10.1097/01.COC.0000026833.73428.1F]
30 Kim TH,Han SS,Park SJ,Lee WJ,Woo SM,Moon SH,Yoo T,Kim SS,Kim SH,Hong EK,Kim DY,Park JW.Role of adjuvant chemoradiotherapy for resected extrahepatic biliary tract cancer.Int J Radiat Oncol Biol Phys 2011;81:e853-e859[PMID:21497455 DOI:10.1016/j.ijrobp.2010.12.019]
31 Gwak HK,Kim WC,Kim HJ,Park JH.Extrahepatic bile duct cancers:surgery alone versus surgery plus postoperative radiation therapy.Int J Radiat Oncol Biol Phys 2010;78:194-198[PMID:19910130 DOI:10.1016/j.ijrobp.2009.07.003]
32 Im JH,Seong J,Lee IJ,Park JS,Yoon DS,Kim KS,Lee WJ,Park KR.Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer:Treatment Outcome Analysis of 336 Patients.Cancer Res Treat 2016;48:583-595[PMID:26323644 DOI:10.4143/crt.2015.091]
33 Kim MY,Kim JH,Kim Y,Byun SJ.Postoperative radiotherapy appeared to improve the disease free survival rate of patients with extrahepatic bile duct cancer at high risk of loco-regional recurrence.Radiat Oncol J 2016;34:297-304[PMID:27951624 DOI:10.3857/roj.2016.01879]
34 Kim YJ,Kim K,Min SK,Nam EM.Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer.Br J Radiol 2017;90:20160807[PMID:28118028 DOI:10.1259/bjr.20160807]
35 Borghero Y,Crane CH,Szklaruk J,Oyarzo M,Curley S,Pisters PW,Evans D,Abdalla EK,Thomas MB,Das P,Wistuba II,Krishnan S,Vauthey JN.Extrahepatic bile duct adenocarcinoma:patients at high-risk for local recurrence treated with surgery and adjuvant chemoradiation have an equivalent overall survival to patients with standard-risk treated with surgery alone.Ann Surg Oncol 2008;15:3147-3156[PMID:18754070 DOI:10.1245/s10434-008-9998-7]
36 Matsuda T,Fujita H,Harada N,Kunimoto Y,Tanaka T,Kimura T,Kitaoka H,Asano E,Hosono M,Hayashi T,Ogino K.Impact of adjuvant radiation therapy for microscopic residual tumor after resection of extrahepatic bile duct cancer.Am J Clin Oncol 2013;36:461-465[PMID:22706178 DOI:10.1097/COC.0b013e31825494ab]
37 Lee J,Kang SH,Noh OK,Chun M,Oh YT,Kim BW,Kim SW.Adjuvant concurrent chemoradiation therapy in patients with microscopic residual tumor after curative resection for extrahepatic cholangiocarcinoma.Clin Transl Oncol 2018;20:1011-1017[PMID:29256155 DOI:10.1007/s12094-017-1815-y]
38 Khan SA,Davidson BR,Goldin RD,Heaton N,Karani J,Pereira SP,Rosenberg WM,Tait P,TaylorRobinson SD,Thillainayagam AV,Thomas HC,Wasan H;British Society of Gastroenterology.Guidelines for the diagnosis and treatment of cholangiocarcinoma:an update.Gut 2012;61:1657-1669[PMID:22895392 DOI:10.1136/gutjnl-2011-301748]
39 Lee KJ,Yi SW,Cha J,Seong J,Bang S,Song SY,Kim HM,Park SW.A pilot study of concurrent chemoradiotherapy with gemcitabine and cisplatin in patients with locally advanced biliary tract cancer.Cancer Chemother Pharmacol 2016;78:841-846[PMID:27586966 DOI:10.1007/s00280-016-3143-2]
40 Shinohara ET,Mitra N,Guo M,Metz JM.Radiotherapy is associated with improved survival in adjuvant and palliative treatment of extrahepatic cholangiocarcinomas.Int J Radiat Oncol Biol Phys 2009;74:1191-1198[PMID:19201549 DOI:10.1016/j.ijrobp.2008.09.017]
41 Pollom EL,Alagappan M,Park LS,Whittemore AS,Koong AC,Chang DT.Does radiotherapy still have a role in unresected biliary tract cancer?Cancer Med 2017;6:129-141[PMID:27891822 DOI:10.1002/cam4.975]
42 Torgeson A,Lloyd S,Boothe D,Cannon G,Garrido-Laguna I,Whisenant J,Lewis M,Kim R,Scaife C,Tao R.Chemoradiation Therapy for Unresected Extrahepatic Cholangiocarcinoma:A Propensity ScoreMatched Analysis.Ann Surg Oncol 2017;24:4001-4008[PMID:29043526 DOI:10.1245/s10434-017-6131-9]
43 Schoppmeyer K,Miethe S,Wiedmann M,Liebmann A,Hauss J,Mossner J,Caca K,Witzigmann H,Hildebrandt G.Radiochemotherapy followed by gemcitabine and capecitabine in extrahepatic bile duct cancer:a phase I/II trial.Am J Clin Oncol 2006;29:576-582[PMID:17148994 DOI:10.1097/01.coc.0000239167.17922.82]
44 Deodato F,Clemente G,Mattiucci GC,Macchia G,Costamagna G,Giuliante F,Smaniotto D,Luzi S,Valentini V,Mutignani M,Nuzzo G,Cellini N,Morganti AG.Chemoradiation and brachytherapy in biliary tract carcinoma:long-term results.Int J Radiat Oncol Biol Phys 2006;64:483-488[PMID:16242254 DOI:10.1016/j.ijrobp.2005.07.977]
45 Brunner TB,Schwab D,Meyer T,Sauer R.Chemoradiation may prolong survival of patients with nonbulky unresectable extrahepatic biliary carcinoma.A retrospective analysis.Strahlenther Onkol 2004;180:751-757[PMID:15592694 DOI:10.1007/s00066-004-1315-1]
46 Schleicher UM,Staatz G,Alzen G,Andreopoulos D.Combined external beam and intraluminal radiotherapy for irresectable Klatskin tumors.Strahlenther Onkol 2002;178:682-687[PMID:12491056DOI:10.1007/s00066-002-0947-2]
47 Autorino R,Mattiucci GC,Ardito F,Balducci M,Deodato F,Macchia G,Mantini G,Perri V,Tringali A,Gambacorta MA,Tagliaferri L,Giuliante F,Morganti AG,Valentini V.Radiochemotherapy with Gemcitabine in Unresectable Extrahepatic Cholangiocarcinoma:Long-term Results of a Phase II Study.Anticancer Res 2016;36:737-740[PMID:26851032]
48 Takamura A,Saito H,Kamada T,Hiramatsu K,Takeuchi S,Hasegawa M,Miyamoto N.Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma.Int J Radiat Oncol Biol Phys 2003;57:1357-1365[PMID:14630274]
49 Shin HS,Seong J,Kim WC,Lee HS,Moon SR,Lee IJ,Lee KK,Park KR,Suh CO,Kim GE.Combination of external beam irradiation and high-dose-rate intraluminal brachytherapy for inoperable carcinoma of the extrahepatic bile ducts.Int J Radiat Oncol Biol Phys 2003;57:105-112[PMID:12909222]
50 Yoshioka Y,Ogawa K,Oikawa H,Onishi H,Kanesaka N,Tamamoto T,Kosugi T,Hatano K,Kobayashi M,Ito Y,Takayama M,Takemoto M,Karasawa K,Nagakura H,Imai M,Kosaka Y,Yamazaki H,Isohashi F,Nemoto K,Nishimura Y;Japanese Radiation Oncology Study Group(JROSG).Impact of intraluminal brachytherapy on survival outcome for radiation therapy for unresectable biliary tract cancer:a propensity-score matched-pair analysis.Int J Radiat Oncol Biol Phys 2014;89:822-829[PMID:24969796 DOI:10.1016/j.ijrobp.2014.04.020]
51 Kopek N,Holt MI,Hansen AT,H?yer M.Stereotactic body radiotherapy for unresectable cholangiocarcinoma.Radiother Oncol 2010;94:47-52[PMID:19963295 DOI:10.1016/j.radonc.2009.11.004]
52 Momm F,Schubert E,Henne K,Hodapp N,Frommhold H,Harder J,Grosu AL,Becker G.Stereotactic fractionated radiotherapy for Klatskin tumours.Radiother Oncol 2010;95:99-102[PMID:20347169 DOI:10.1016/j.radonc.2010.03.013]
53 Polistina FA,Guglielmi R,Baiocchi C,Francescon P,Scalchi P,Febbraro A,Costantin G,Ambrosino G.Chemoradiation treatment with gemcitabine plus stereotactic body radiotherapy for unresectable,nonmetastatic,locally advanced hilar cholangiocarcinoma.Results of a five year experience.Radiother Oncol2011;99:120-123[PMID:21621289 DOI:10.1016/j.radonc.2011.05.016]
54 Jung DH,Kim MS,Cho CK,Yoo HJ,Jang WI,Seo YS,Paik EK,Kim KB,Han CJ,Kim SB.Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma.Radiat Oncol J 2014;32:163-169[PMID:25324988 DOI:10.3857/roj.2014.32.3.163]
55 Speer AG,Cotton PB,Russell RC,Mason RR,Hatfield AR,Leung JW,MacRae KD,Houghton J,Lennon CA.Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice.Lancet 1987;2:57-62[PMID:2439854]
56 Xu X,Li J,Wu J,Zhu R,Ji W.A Systematic Review and Meta-analysis of Intraluminal Brachytherapy Versus Stent Alone in the Treatment of Malignant Obstructive Jaundice.Cardiovasc Intervent Radiol2018;41:206-217[PMID:29075881 DOI:10.1007/s00270-017-1827-6]
57 Bowling TE,Galbraith SM,Hatfield AR,Solano J,Spittle MF.A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma.Gut 1996;39:852-855[PMID:9038668]
58 Válek V,Kysela P,Kala Z,Kiss I,Tomásek J,Petera J.Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma:a prospective randomised study.Eur J Radiol 2007;62:175-179[PMID:17344008 DOI:10.1016/j.ejrad.2007.01.037]
59 Isayama H,Tsujino T,Nakai Y,Sasaki T,Nakagawa K,Yamashita H,Aoki T,Koike K.Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma.World JGastroenterol 2012;18:2364-2370[PMID:22654427 DOI:10.3748/wjg.v18.i19.2364]
60 Lee JK,Kwack WK,Lee SH,Jung JH,Kwon JH,Han IW,Lee JH.Effect of external beam radiotherapy on patency of uncovered metallic stents in patients with inoperable bile duct cancer.Hepatobiliary Pancreat Dis Int 2014;13:423-427[PMID:25100128]
61 Shinchi H,Takao S,Nishida H,Aikou T.Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma.J Surg Oncol 2000;75:89-94[PMID:11064386]
62 Tan Y,Zhu JY,Qiu BA,Xia NX,Wang JH.Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma.Oncol Lett 2015;10:2537-2542[PMID:26622885DOI:10.3892/ol.2015.3589]
63 Ghiassi-Nejad Z,Tarchi P,Moshier E,Ru M,Tabrizian P,Schwartz M,Buckstein M.Prognostic Factors and Patterns of Locoregional Failure After Surgical Resection in Patients With Cholangiocarcinoma Without Adjuvant Radiation Therapy:Optimal Field Design for Adjuvant Radiation Therapy.Int J Radiat Oncol Biol Phys 2017;99:805-811[PMID:29063849 DOI:10.1016/j.ijrobp.2017.06.2467]
64 Socha J,Michalak M,Wo??kiewicz G,Kepka L.Nodal areas of potential geographic error in adjuvant radiotherapy for biliary tract cancer.Radiother Oncol 2017;125:365-373[PMID:29033254 DOI:10.1016/j.radonc.2017.09.025]
65 Bisello S,Renzulli M,Buwenge M,Calculli L,Sallustio G,Macchia G,Deodato F,Mattiucci G,Cammelli S,Arcelli A,Giaccherini L,Cellini F,Brandi G,Guerri S,Cilla S,Golfieri R,Fuccio L,Morganti AG,Guido A.An atlas for clinical target volume definition,including elective nodal irradiation in definitive radiotherapy of biliary cancer.Oncol Lett 2019;17:1784-1790[PMID:30675238 DOI:10.3892/ol.2018.9774]
2 Jarnagin WR,Fong Y,DeMatteo RP,Gonen M,Burke EC,Bodniewicz BS J,Youssef BA M,Klimstra D,Blumgart LH.Staging,resectability,and outcome in 225 patients with hilar cholangiocarcinoma.Ann Surg 2001;234:507-517;discussion 517-519[PMID:11573044]
3 Kosuge T,Yamamoto J,Shimada K,Yamasaki S,Makuuchi M.Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection.Ann Surg 1999;230:663-671[PMID:10561090]
4 Wakai T,Shirai Y,Moroda T,Yokoyama N,Hatakeyama K.Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma.Cancer 2005;103:1210-1216[PMID:15685618 DOI:10.1002/cncr.20906]
5 Jang JY,Kim SW,Park DJ,Ahn YJ,Yoon YS,Choi MG,Suh KS,Lee KU,Park YH.Actual long-term outcome of extrahepatic bile duct cancer after surgical resection.Ann Surg 2005;241:77-84[PMID:15621994]
6 Hemming AW,Reed AI,Fujita S,Foley DP,Howard RJ.Surgical management of hilar cholangiocarcinoma.Ann Surg 2005;241:693-699;discussion 699-702[PMID:15849505]
7 Ebata T,Hirano S,Konishi M,Uesaka K,Tsuchiya Y,Ohtsuka M,Kaneoka Y,Yamamoto M,Ambo Y,Shimizu Y,Ozawa F,Fukutomi A,Ando M,Nimura Y,Nagino M;Bile Duct Cancer Adjuvant Trial(BCAT)Study Group.Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer.Br J Surg 2018;105:192-202[PMID:29405274 DOI:10.1002/bjs.10776]
8 Edeline J,Benabdelghani M,Bertaut A,Watelet J,Hammel P,Joly JP,Boudjema K,Fartoux L,BouhierLeporrier K,Jouve JL,Faroux R,Guerin-Meyer V,Kurtz JE,Assénat E,Seitz JF,Baumgaertner I,Tougeron D,de la Fouchardière C,Lombard-Bohas C,Boucher E,Stanbury T,Louvet C,Malka D,Phelip JM.Gemcitabine and Oxaliplatin Chemotherapy or Surveillance in Resected Biliary Tract Cancer(PRODIGE 12-ACCORD 18-UNICANCER GI):A Randomized Phase III Study.J Clin Oncol 2019;37:658-667[PMID:30707660 DOI:10.1200/JCO.18.00050]
9 Valle J,Wasan H,Palmer DH,Cunningham D,Anthoney A,Maraveyas A,Madhusudan S,Iveson T,Hughes S,Pereira SP,Roughton M,Bridgewater J;ABC-02 Trial Investigators.Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.N Engl J Med 2010;362:1273-1281[PMID:20375404 DOI:10.1056/NEJMoa0908721]
10 Choi HS,Kang KM,Jeong BK,Jeong H,Lee YH,Ha IB,Kim TG,Song JH.Patterns of failure after resection of extrahepatic bile duct cancer:implications for adjuvant radiotherapy indication and treatment volumes.Radiat Oncol 2018;13:85[PMID:29739420 DOI:10.1186/s13014-018-1024-z]
11 Koo TR,Eom KY,Kim IA,Cho JY,Yoon YS,Hwang DW,Han HS,Kim JS.Patterns of failure and prognostic factors in resected extrahepatic bile duct cancer:implication for adjuvant radiotherapy.Radiat Oncol J 2014;32:63-69[PMID:25061574 DOI:10.3857/roj.2014.32.2.63]
12 Jarnagin WR,Ruo L,Little SA,Klimstra D,D'Angelica M,DeMatteo RP,Wagman R,Blumgart LH,Fong Y.Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma:implications for adjuvant therapeutic strategies.Cancer 2003;98:1689-1700[PMID:14534886 DOI:10.1002/cncr.11699]
13 Sakamoto E,Nimura Y,Hayakawa N,Kamiya J,Kondo S,Nagino M,Kanai M,Miyachi M,Uesaka K.The pattern of infiltration at the proximal border of hilar bile duct carcinoma:a histologic analysis of 62resected cases.Ann Surg 1998;227:405-411[PMID:9527064]
14 Burke EC,Jarnagin WR,Hochwald SN,Pisters PW,Fong Y,Blumgart LH.Hilar Cholangiocarcinoma:patterns of spread,the importance of hepatic resection for curative operation,and a presurgical clinical staging system.Ann Surg 1998;228:385-394[PMID:9742921]
15 Sakamoto Y,Kosuge T,Shimada K,Sano T,Ojima H,Yamamoto J,Yamasaki S,Takayama T,Makuuchi M.Prognostic factors of surgical resection in middle and distal bile duct cancer:an analysis of 55 patients concerning the significance of ductal and radial margins.Surgery 2005;137:396-402[PMID:15800484DOI:10.1016/j.surg.2004.10.008]
16 Kim K,Chie EK,Jang JY,Kim SW,Han SW,Oh DY,Im SA,Kim TY,Bang YJ,Ha SW.Adjuvant chemoradiotherapy after curative resection for extrahepatic bile duct cancer:a long-term single center experience.Am J Clin Oncol 2012;35:136-140[PMID:21325937 DOI:10.1097/COC.0b013e318209aa29]
17 Park JH,Choi EK,Ahn SD,Lee SW,Song SY,Yoon SM,Kim YS,Lee YS,Lee SG,Hwang S,Lee YJ,Park KM,Kim TW,Chang HM,Lee JL,Kim JH.Postoperative chemoradiotherapy for extrahepatic bile duct cancer.Int J Radiat Oncol Biol Phys 2011;79:696-704[PMID:20510541 DOI:10.1016/j.ijrobp.2009.12.031]
18 Nelson JW,Ghafoori AP,Willett CG,Tyler DS,Pappas TN,Clary BM,Hurwitz HI,Bendell JC,Morse MA,Clough RW,Czito BG.Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma.Int J Radiat Oncol Biol Phys 2009;73:148-153[PMID:18805651 DOI:10.1016/j.ijrobp.2008.07.008]
19 Ben-David MA,Griffith KA,Abu-Isa E,Lawrence TS,Knol J,Zalupski M,Ben-Josef E.External-beam radiotherapy for localized extrahepatic cholangiocarcinoma.Int J Radiat Oncol Biol Phys 2006;66:772-779[PMID:17011452 DOI:10.1016/j.ijrobp.2006.05.061]
20 Oh D,Lim DH,Heo JS,Choi SH,Choi DW,Ahn YC,Park W,Huh SJ.The role of adjuvant radiotherapy in microscopic tumor control after extrahepatic bile duct cancer surgery.Am J Clin Oncol 2007;30:21-25[PMID:17278890 DOI:10.1097/01.coc.0000245467.97180.78]
21 Ben-Josef E,Guthrie KA,El-Khoueiry AB,Corless CL,Zalupski MM,Lowy AM,Thomas CR,Alberts SR,Dawson LA,Micetich KC,Thomas MB,Siegel AB,Blanke CD.SWOG S0809:A Phase II Intergroup Trial of Adjuvant Capecitabine and Gemcitabine Followed by Radiotherapy and Concurrent Capecitabine in Extrahepatic Cholangiocarcinoma and Gallbladder Carcinoma.J Clin Oncol 2015;33:2617-2622[PMID:25964250 DOI:10.1200/JCO.2014.60.2219]
22 Pitt HA,Nakeeb A,Abrams RA,Coleman J,Piantadosi S,Yeo CJ,Lillemore KD,Cameron JL.Perihilar cholangiocarcinoma.Postoperative radiotherapy does not improve survival.Ann Surg 1995;221:788-97;discussion 797-8[PMID:7794082]
23 Vern-Gross TZ,Shivnani AT,Chen K,Lee CM,Tward JD,MacDonald OK,Crane CH,Talamonti MS,Munoz LL,Small W.Survival outcomes in resected extrahepatic cholangiocarcinoma:effect of adjuvant radiotherapy in a surveillance,epidemiology,and end results analysis.Int J Radiat Oncol Biol Phys 2011;81:189-198[PMID:20971573 DOI:10.1016/j.ijrobp.2010.05.001]
24 Yu JB,Decker RH,Knisely JP.The role of postoperative radiation therapy(PORT)in the treatment of extrahepatic bile duct cancer:a surveillance,epidemiology,and end results(SEER)population-based investigation.J Gastrointest Cancer 2008;39:11-21[PMID:19156542 DOI:10.1007/s12029-008-9045-8]
25 Hoehn RS,Wima K,Ertel AE,Meier A,Ahmad SA,Shah SA,Abbott DE.Adjuvant Chemotherapy and Radiation Therapy is Associated with Improved Survival for Patients with Extrahepatic Cholangiocarcinoma.Ann Surg Oncol 2015;22 Suppl 3:S1133-S1139[PMID:25976862 DOI:10.1245/s10434-015-4599-8]
26 Ecker BL,Vining CC,Roses RE,Maggino L,Lee MK,Drebin JA,Fraker DL,Vollmer CM,Datta J.Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of the Extrahepatic Bile Ducts:A Propensity Score-Matched Analysis.Ann Surg Oncol 2017;24:3926-3933[PMID:28952140DOI:10.1245/s10434-017-6095-9]
27 Krasnick BA,Jin LX,Davidson JT 4th,Sanford DE,Ethun CG,Pawlik TM,Poultsides GA,Tran T,Idrees K,Hawkins WG,Chapman WC,Doyle MBM,Weber SM,Strasberg SM,Salem A,Martin RCG,Isom CA,Scoggins C,Schmidt CR,Shen P,Beal E,Hatzaras I,Shenoy R,Maithel SK,Fields RC.Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma:A multi-institution analysis from the U.S.extrahepatic biliary malignancy consortium.J Surg Oncol 2018;117:363-371[PMID:29284072 DOI:10.1002/jso.24836]
28 Todoroki T,Ohara K,Kawamoto T,Koike N,Yoshida S,Kashiwagi H,Otsuka M,Fukao K.Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma.Int J Radiat Oncol Biol Phys 2000;46:581-587[PMID:10701737]
29 Heron DE,Stein DE,Eschelman DJ,Topham AK,Waterman FM,Rosato EL,Alden M,Anne PR.Cholangiocarcinoma:the impact of tumor location and treatment strategy on outcome.Am J Clin Oncol2003;26:422-428[PMID:12902899 DOI:10.1097/01.COC.0000026833.73428.1F]
30 Kim TH,Han SS,Park SJ,Lee WJ,Woo SM,Moon SH,Yoo T,Kim SS,Kim SH,Hong EK,Kim DY,Park JW.Role of adjuvant chemoradiotherapy for resected extrahepatic biliary tract cancer.Int J Radiat Oncol Biol Phys 2011;81:e853-e859[PMID:21497455 DOI:10.1016/j.ijrobp.2010.12.019]
31 Gwak HK,Kim WC,Kim HJ,Park JH.Extrahepatic bile duct cancers:surgery alone versus surgery plus postoperative radiation therapy.Int J Radiat Oncol Biol Phys 2010;78:194-198[PMID:19910130 DOI:10.1016/j.ijrobp.2009.07.003]
32 Im JH,Seong J,Lee IJ,Park JS,Yoon DS,Kim KS,Lee WJ,Park KR.Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer:Treatment Outcome Analysis of 336 Patients.Cancer Res Treat 2016;48:583-595[PMID:26323644 DOI:10.4143/crt.2015.091]
33 Kim MY,Kim JH,Kim Y,Byun SJ.Postoperative radiotherapy appeared to improve the disease free survival rate of patients with extrahepatic bile duct cancer at high risk of loco-regional recurrence.Radiat Oncol J 2016;34:297-304[PMID:27951624 DOI:10.3857/roj.2016.01879]
34 Kim YJ,Kim K,Min SK,Nam EM.Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer.Br J Radiol 2017;90:20160807[PMID:28118028 DOI:10.1259/bjr.20160807]
35 Borghero Y,Crane CH,Szklaruk J,Oyarzo M,Curley S,Pisters PW,Evans D,Abdalla EK,Thomas MB,Das P,Wistuba II,Krishnan S,Vauthey JN.Extrahepatic bile duct adenocarcinoma:patients at high-risk for local recurrence treated with surgery and adjuvant chemoradiation have an equivalent overall survival to patients with standard-risk treated with surgery alone.Ann Surg Oncol 2008;15:3147-3156[PMID:18754070 DOI:10.1245/s10434-008-9998-7]
36 Matsuda T,Fujita H,Harada N,Kunimoto Y,Tanaka T,Kimura T,Kitaoka H,Asano E,Hosono M,Hayashi T,Ogino K.Impact of adjuvant radiation therapy for microscopic residual tumor after resection of extrahepatic bile duct cancer.Am J Clin Oncol 2013;36:461-465[PMID:22706178 DOI:10.1097/COC.0b013e31825494ab]
37 Lee J,Kang SH,Noh OK,Chun M,Oh YT,Kim BW,Kim SW.Adjuvant concurrent chemoradiation therapy in patients with microscopic residual tumor after curative resection for extrahepatic cholangiocarcinoma.Clin Transl Oncol 2018;20:1011-1017[PMID:29256155 DOI:10.1007/s12094-017-1815-y]
38 Khan SA,Davidson BR,Goldin RD,Heaton N,Karani J,Pereira SP,Rosenberg WM,Tait P,TaylorRobinson SD,Thillainayagam AV,Thomas HC,Wasan H;British Society of Gastroenterology.Guidelines for the diagnosis and treatment of cholangiocarcinoma:an update.Gut 2012;61:1657-1669[PMID:22895392 DOI:10.1136/gutjnl-2011-301748]
39 Lee KJ,Yi SW,Cha J,Seong J,Bang S,Song SY,Kim HM,Park SW.A pilot study of concurrent chemoradiotherapy with gemcitabine and cisplatin in patients with locally advanced biliary tract cancer.Cancer Chemother Pharmacol 2016;78:841-846[PMID:27586966 DOI:10.1007/s00280-016-3143-2]
40 Shinohara ET,Mitra N,Guo M,Metz JM.Radiotherapy is associated with improved survival in adjuvant and palliative treatment of extrahepatic cholangiocarcinomas.Int J Radiat Oncol Biol Phys 2009;74:1191-1198[PMID:19201549 DOI:10.1016/j.ijrobp.2008.09.017]
41 Pollom EL,Alagappan M,Park LS,Whittemore AS,Koong AC,Chang DT.Does radiotherapy still have a role in unresected biliary tract cancer?Cancer Med 2017;6:129-141[PMID:27891822 DOI:10.1002/cam4.975]
42 Torgeson A,Lloyd S,Boothe D,Cannon G,Garrido-Laguna I,Whisenant J,Lewis M,Kim R,Scaife C,Tao R.Chemoradiation Therapy for Unresected Extrahepatic Cholangiocarcinoma:A Propensity ScoreMatched Analysis.Ann Surg Oncol 2017;24:4001-4008[PMID:29043526 DOI:10.1245/s10434-017-6131-9]
43 Schoppmeyer K,Miethe S,Wiedmann M,Liebmann A,Hauss J,Mossner J,Caca K,Witzigmann H,Hildebrandt G.Radiochemotherapy followed by gemcitabine and capecitabine in extrahepatic bile duct cancer:a phase I/II trial.Am J Clin Oncol 2006;29:576-582[PMID:17148994 DOI:10.1097/01.coc.0000239167.17922.82]
44 Deodato F,Clemente G,Mattiucci GC,Macchia G,Costamagna G,Giuliante F,Smaniotto D,Luzi S,Valentini V,Mutignani M,Nuzzo G,Cellini N,Morganti AG.Chemoradiation and brachytherapy in biliary tract carcinoma:long-term results.Int J Radiat Oncol Biol Phys 2006;64:483-488[PMID:16242254 DOI:10.1016/j.ijrobp.2005.07.977]
45 Brunner TB,Schwab D,Meyer T,Sauer R.Chemoradiation may prolong survival of patients with nonbulky unresectable extrahepatic biliary carcinoma.A retrospective analysis.Strahlenther Onkol 2004;180:751-757[PMID:15592694 DOI:10.1007/s00066-004-1315-1]
46 Schleicher UM,Staatz G,Alzen G,Andreopoulos D.Combined external beam and intraluminal radiotherapy for irresectable Klatskin tumors.Strahlenther Onkol 2002;178:682-687[PMID:12491056DOI:10.1007/s00066-002-0947-2]
47 Autorino R,Mattiucci GC,Ardito F,Balducci M,Deodato F,Macchia G,Mantini G,Perri V,Tringali A,Gambacorta MA,Tagliaferri L,Giuliante F,Morganti AG,Valentini V.Radiochemotherapy with Gemcitabine in Unresectable Extrahepatic Cholangiocarcinoma:Long-term Results of a Phase II Study.Anticancer Res 2016;36:737-740[PMID:26851032]
48 Takamura A,Saito H,Kamada T,Hiramatsu K,Takeuchi S,Hasegawa M,Miyamoto N.Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma.Int J Radiat Oncol Biol Phys 2003;57:1357-1365[PMID:14630274]
49 Shin HS,Seong J,Kim WC,Lee HS,Moon SR,Lee IJ,Lee KK,Park KR,Suh CO,Kim GE.Combination of external beam irradiation and high-dose-rate intraluminal brachytherapy for inoperable carcinoma of the extrahepatic bile ducts.Int J Radiat Oncol Biol Phys 2003;57:105-112[PMID:12909222]
50 Yoshioka Y,Ogawa K,Oikawa H,Onishi H,Kanesaka N,Tamamoto T,Kosugi T,Hatano K,Kobayashi M,Ito Y,Takayama M,Takemoto M,Karasawa K,Nagakura H,Imai M,Kosaka Y,Yamazaki H,Isohashi F,Nemoto K,Nishimura Y;Japanese Radiation Oncology Study Group(JROSG).Impact of intraluminal brachytherapy on survival outcome for radiation therapy for unresectable biliary tract cancer:a propensity-score matched-pair analysis.Int J Radiat Oncol Biol Phys 2014;89:822-829[PMID:24969796 DOI:10.1016/j.ijrobp.2014.04.020]
51 Kopek N,Holt MI,Hansen AT,H?yer M.Stereotactic body radiotherapy for unresectable cholangiocarcinoma.Radiother Oncol 2010;94:47-52[PMID:19963295 DOI:10.1016/j.radonc.2009.11.004]
52 Momm F,Schubert E,Henne K,Hodapp N,Frommhold H,Harder J,Grosu AL,Becker G.Stereotactic fractionated radiotherapy for Klatskin tumours.Radiother Oncol 2010;95:99-102[PMID:20347169 DOI:10.1016/j.radonc.2010.03.013]
53 Polistina FA,Guglielmi R,Baiocchi C,Francescon P,Scalchi P,Febbraro A,Costantin G,Ambrosino G.Chemoradiation treatment with gemcitabine plus stereotactic body radiotherapy for unresectable,nonmetastatic,locally advanced hilar cholangiocarcinoma.Results of a five year experience.Radiother Oncol2011;99:120-123[PMID:21621289 DOI:10.1016/j.radonc.2011.05.016]
54 Jung DH,Kim MS,Cho CK,Yoo HJ,Jang WI,Seo YS,Paik EK,Kim KB,Han CJ,Kim SB.Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma.Radiat Oncol J 2014;32:163-169[PMID:25324988 DOI:10.3857/roj.2014.32.3.163]
55 Speer AG,Cotton PB,Russell RC,Mason RR,Hatfield AR,Leung JW,MacRae KD,Houghton J,Lennon CA.Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice.Lancet 1987;2:57-62[PMID:2439854]
56 Xu X,Li J,Wu J,Zhu R,Ji W.A Systematic Review and Meta-analysis of Intraluminal Brachytherapy Versus Stent Alone in the Treatment of Malignant Obstructive Jaundice.Cardiovasc Intervent Radiol2018;41:206-217[PMID:29075881 DOI:10.1007/s00270-017-1827-6]
57 Bowling TE,Galbraith SM,Hatfield AR,Solano J,Spittle MF.A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma.Gut 1996;39:852-855[PMID:9038668]
58 Válek V,Kysela P,Kala Z,Kiss I,Tomásek J,Petera J.Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma:a prospective randomised study.Eur J Radiol 2007;62:175-179[PMID:17344008 DOI:10.1016/j.ejrad.2007.01.037]
59 Isayama H,Tsujino T,Nakai Y,Sasaki T,Nakagawa K,Yamashita H,Aoki T,Koike K.Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma.World JGastroenterol 2012;18:2364-2370[PMID:22654427 DOI:10.3748/wjg.v18.i19.2364]
60 Lee JK,Kwack WK,Lee SH,Jung JH,Kwon JH,Han IW,Lee JH.Effect of external beam radiotherapy on patency of uncovered metallic stents in patients with inoperable bile duct cancer.Hepatobiliary Pancreat Dis Int 2014;13:423-427[PMID:25100128]
61 Shinchi H,Takao S,Nishida H,Aikou T.Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma.J Surg Oncol 2000;75:89-94[PMID:11064386]
62 Tan Y,Zhu JY,Qiu BA,Xia NX,Wang JH.Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma.Oncol Lett 2015;10:2537-2542[PMID:26622885DOI:10.3892/ol.2015.3589]
63 Ghiassi-Nejad Z,Tarchi P,Moshier E,Ru M,Tabrizian P,Schwartz M,Buckstein M.Prognostic Factors and Patterns of Locoregional Failure After Surgical Resection in Patients With Cholangiocarcinoma Without Adjuvant Radiation Therapy:Optimal Field Design for Adjuvant Radiation Therapy.Int J Radiat Oncol Biol Phys 2017;99:805-811[PMID:29063849 DOI:10.1016/j.ijrobp.2017.06.2467]
64 Socha J,Michalak M,Wo??kiewicz G,Kepka L.Nodal areas of potential geographic error in adjuvant radiotherapy for biliary tract cancer.Radiother Oncol 2017;125:365-373[PMID:29033254 DOI:10.1016/j.radonc.2017.09.025]
65 Bisello S,Renzulli M,Buwenge M,Calculli L,Sallustio G,Macchia G,Deodato F,Mattiucci G,Cammelli S,Arcelli A,Giaccherini L,Cellini F,Brandi G,Guerri S,Cilla S,Golfieri R,Fuccio L,Morganti AG,Guido A.An atlas for clinical target volume definition,including elective nodal irradiation in definitive radiotherapy of biliary cancer.Oncol Lett 2019;17:1784-1790[PMID:30675238 DOI:10.3892/ol.2018.9774]