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

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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).

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.