Adjuvant chemoradiation in lymph node-positive biliary tract cancers shows promise

Amongst patients with extrahepatic cholangiocarcinoma (EHCC) and gallbladder cancer (GBCA), adjuvant chemotherapy followed by chemoradiation is associated with favorable outcomes independent of nodal status, according to a study.

Adjuvant therapy may also impact local control in patients who are node-positive (N+).

In this secondary analysis of a single-arm clinical trial, the outcomes of 46 patients with resected EHCC and 23 patients with resected GBCA, who were stage pT2-4, N+, or margin-positive (R1) and had completed 4 cycles of chemotherapy followed by radiotherapy, were evaluated. Participants had a median age of 61.7 years and an R0 rate of 66.7% and R1 rate of 33.3%. Overall, 73.9% of patients with EHCC were N+ compared to 47.8% of patients with GBCA.

Overall survival or disease-free survival (DFS) was not significantly impacted by nodal status.

The 2-year overall survival for node-negative (N0) disease and 60.9% for N+ disease was 70.6% and 60.9%, respectively, whereas 2-year DFS for N0 tumors and N+ tumors was 62.5% and 49.8%, respectively.

Rates of distant failure were 42.2% in N+ tumors and 25% in N0 tumors.

Compared to historical controls, the 2-year DFS rate in N+ tumors was significantly higher (49.8% vs. 29.7%, P = 0.004).

Reference
Gholami S, Colby S, Horowitz DP, et al. Adjuvant Chemoradiation in Patients with Lymph Node-Positive Biliary Tract Cancers: Secondary Analysis of a Single-Arm Clinical Trial (SWOG 0809). Ann Surg Oncol. 2023;30(3):1354-1363. doi: 10.1245/s10434-022-12863-9. Epub 2023 Jan 9. PMID: 36622529.