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Adjuvant Concurrent Chemoradiotherapy in Patients with Extrahepatic CCA

2020 Year in Review: Cholangiocarcinoma — December 18, 2020

Retrospective analysis data indicate that adjuvant chemoradiotherapy was associated with improved survival compared with chemotherapy alone in patients with extrahepatic CCA.

The current standard-of-care treatment in patients with resected extrahepatic CCA is 6 months of adjuvant capecitabine chemotherapy.1 However, the benefit of treatment with adjuvant radiation therapy is not well-defined.

Based on the National Cancer Database data, a study presented at this year’s annual meeting of the American Society of Clinical Oncology (ASCO) evaluated survival outcomes with adjuvant chemoradiotherapy compared with chemotherapy alone in patients with extrahepatic CCA.2 Walid L. Shaib, MD, Medical Oncologist, Winship Cancer Institute of Emory University, Atlanta, GA, led the study.

Patients with resected stage I to stage III extrahepatic CCA between 2004 and 2013 were identified from the National Cancer Database. Excluded from this analysis were patients who had received neoadjuvant therapy. Univariate and multivariable analyses were conducted, and Kaplan-Meier curves were used to compare the overall survival (OS) of the patients based on the treatment received.

A total of 236 patients with extrahepatic CCA were identified by the investigators, including 68 (28.8%) patients with stage I disease, 134 (56.8%) with stage II disease, and 34 (14.4%) with stage III disease. A total of 89 (37.7%) patients received adjuvant chemotherapy and 147 (62.3%) patients received adjuvant chemoradiotherapy. The median dose of radiation was 50.4 Gy. In patients with regional node-positive disease (P = .016) and in patients with negative surgical margins (P = .002), adjuvant chemoradiotherapy was predominantly used.

Adjuvant chemoradiotherapy use was associated with improved OS compared with chemotherapy alone in univariate (hazard ratio, 0.64; P = .019) and multivariable (hazard ratio, 0.65; P = .030) analyses. Median OS was 33.8 months, and the 1-year OS rate was 87.7% in patients who received chemoradiotherapy compared with 23.8 months and 75.5%, respectively, in patients who received chemotherapy alone.

The investigators concluded that adjuvant chemoradiotherapy was associated with improved survival in patients with resected extrahepatic CCA compared with chemotherapy alone.


  1. Primrose JN, Fox RP, Palmer DH, et al; for the BILCAP study group. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019;20:663-673. Erratum in: Lancet Oncol. 2019;20:e242.
  2. Shaib WL, Zakka KM, Tian F, et al. Adjuvant concurrent chemoradiotherapy in extrahepatic cholangiocarcinoma. J Clin Oncol. 2020;38(15_suppl):Abstract 4583.


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