Department of Surgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Am J Clin Oncol. 2013 Oct;36(5):461-5. doi: 10.1097/COC.0b013e31825494ab.
The effect of adjuvant radiation therapy (RT) in extrahepatic bile duct (EHBD) cancer patients with microscopic-positive resection margins (R1 resection) is still controversial.
Between January 2000 and March 2010, 52 patients with EHBD cancer underwent surgery at our institution, of whom 36 were subjected to a retrospective analysis. Eleven patients received adjuvant RT after resection [surgery (S)+RT group], which included 9 patients with R1 resection and 2 with para-aortic lymph node metastasis. Their oncological outcomes were analyzed and compared with those of the 25 patients with R0 resection who did not receive adjuvant RT (S group).
Patients in the S+RT group had significantly more advanced disease than those in the S group. However, there was no significant difference in disease-free survival or overall survival between the 2 groups. Median survival times for the S+RT and the S groups were 44 and 47 months, respectively, whereas the 5-year survival rates were 38.9% and 46%, respectively (P=0.707). Locoregional recurrence was less frequent in the S+RT group as compared with the S group, but the incidence of distant metastasis was unaffected by the adjuvant RT.
Our results support the beneficial effect of adjuvant RT in EHBD cancer patients with R1 resection. This effect seems to result from an improved control of the locoregional tumor by adjuvant RT.
辅助放疗（RT）对肝外胆管（EHBD）癌患者镜下阳性切缘（R1 切除）的作用仍存在争议。
2000 年 1 月至 2010 年 3 月，52 例 EHBD 癌患者在我院接受手术治疗，其中 36 例进行了回顾性分析。11 例患者在切除术后接受辅助 RT [手术（S）+RT 组]，其中 9 例为 R1 切除，2 例为腹主动脉旁淋巴结转移。分析并比较了这 11 例患者的肿瘤学结果，以及未接受辅助 RT（S 组）的 25 例 R0 切除患者的结果。
S+RT 组患者的疾病分期明显高于 S 组。然而，两组患者的无病生存率或总生存率均无显著差异。S+RT 组和 S 组的中位生存时间分别为 44 个月和 47 个月，5 年生存率分别为 38.9%和 46%（P=0.707）。与 S 组相比，S+RT 组局部复发率较低，但辅助 RT 对远处转移的发生率无影响。
我们的研究结果支持辅助 RT 对 R1 切除的 EHBD 癌患者有益。这种效果可能是由于辅助 RT 改善了局部肿瘤的控制。
