Radiation Oncology, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès (CST-HGC-CSPT), Barcelona, Spain.
Cancer Treat Rev. 2012 Apr;38(2):111-9. doi: 10.1016/j.ctrv.2011.05.003. Epub 2011 Jun 8.
The role for adjuvant radiotherapy (ART) after curative resection in extrahepatic cholangiocarcinoma remains unclear. Due to the lack of randomized trials, available data comes from single center experiences or data-based population studies with inconclusive results.
To assess the impact of radiotherapy (with or without concurrent chemotherapy) on toxicity and survival of radically resected patients with extrahepatic bile duct cancer (extrahepatic cholangiocarcinoma, gallbladder cancer and pure ampullary cancer).
Eligible studies with data on survival, recurrence and toxicity were retrieved from the MEDLINE, ISI web of science, EMBASE and Cochrane databases from January 1995 to December 2008, to ensure that all ART treatments were performed with conventional 3D techniques. In the absence of randomized controlled-studies, all observational cohort studies (longitudinal and historical) were initially considered. Ten retrospective cohort studies (where the use of concurrent CT was reported only in 2), met all inclusion criteria and were enrolled for final meta-analysis. Hazard ratio (HR) had to be extracted from survival curves using the Tierney et al. methods. MIX 1.7 statistical software was used for meta-analysis.
All studies on ART used conventional 3D-techniques. Patients in the ART cohorts were more likely to have involved surgical margins and positive lymph nodes. For extrahepatic cholangiocarcinoma location, ART significantly improved overall survival (HR 0.62; 95% CI 0.48 to 0.78, p<0.001). Meta-analysis was not feasible for gallbladder cancer and ampullary cancer locations. Late radiation-induced toxicity was low (2-9% late obstruction or GI bleeding).
In the absence of randomized controlled studies, we found in the present systematic review and meta-analysis of observational studies that, patients with extrahepatic cholangiocarcinoma treated with adjuvant RT have a significant lower risk of dying compared to patients treated with surgery alone.
辅助放疗（ART）在肝外胆管癌根治性切除术后的作用仍不清楚。由于缺乏随机试验，现有的数据来自于单中心经验或基于数据的人群研究，结果尚无定论。
评估放疗（伴或不伴同期化疗）对肝外胆管癌（肝外胆管癌、胆囊癌和单纯壶腹癌）根治性切除患者的毒性和生存的影响。
从 MEDLINE、ISI 网络科学、EMBASE 和 Cochrane 数据库中检索了 1995 年 1 月至 2008 年 12 月期间有关生存、复发和毒性的数据的合格研究，以确保所有 ART 治疗均采用传统的 3D 技术进行。在没有随机对照试验的情况下，最初考虑了所有观察性队列研究（纵向和历史）。有 10 项回顾性队列研究（其中只有 2 项报告了同期 CT 的使用）符合所有纳入标准，并纳入最终的荟萃分析。使用 Tierney 等人的方法从生存曲线中提取危险比（HR）。MIX 1.7 统计软件用于荟萃分析。
所有关于 ART 的研究均使用传统的 3D 技术。ART 组的患者更有可能有手术切缘受累和阳性淋巴结。对于肝外胆管癌的位置，ART 显著改善了总生存（HR 0.62；95%CI 0.48 至 0.78，p<0.001）。荟萃分析对于胆囊癌和壶腹癌位置不可行。晚期放射性毒性较低（2-9%的晚期梗阻或胃肠道出血）。
在没有随机对照试验的情况下，我们在本系统评价和观察性研究的荟萃分析中发现，与单独手术治疗的患者相比，接受辅助 RT 治疗的肝外胆管癌患者死亡风险显著降低。
