1 University of Arizona Cancer Center, Tucson, AZ.
2 American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2019 Apr 20;37(12):1015-1027. doi: 10.1200/JCO.18.02178. Epub 2019 Mar 11.
To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with resected biliary tract cancer.
ASCO convened an Expert Panel to conduct a systematic review of the literature on adjuvant therapy for resected biliary tract cancer and provide recommended care options for this patient population.
Three phase III randomized controlled trials, one phase II trial, and 16 retrospective studies met the inclusion criteria.
Based on evidence from a phase III randomized controlled trial, patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy for a duration of 6 months. The dosing used in this trial is described in the qualifying statements, while it should be noted that the dose of capecitabine may also be determined by institutional and regional practices. Patients with extrahepatic cholangiocarcinoma or gallbladder cancer and a microscopically positive surgical resection margin (R1 resection) may be offered chemoradiation therapy. A shared decision-making approach is recommended, considering the risk of harm and potential for benefit associated with radiation therapy for patients with extrahepatic cholangiocarcinoma or gallbladder cancer. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
制定循证临床实践指南，以协助胆道癌切除患者的临床决策。
ASCO 召集专家小组对胆道癌切除的辅助治疗进行系统文献回顾，并为这一患者群体提供推荐的护理选择。
有三项 III 期随机对照试验、一项 II 期试验和 16 项回顾性研究符合纳入标准。
基于 III 期随机对照试验的证据，应向胆道癌切除患者提供为期 6 个月的卡培他滨辅助化疗。本试验中使用的剂量在限定语句中进行了描述，应注意卡培他滨的剂量也可能由机构和地区实践决定。对于有肝外胆管癌或胆囊癌且显微镜下有阳性手术切缘（R1 切除）的患者，可提供放化疗。建议采用共同决策方法，考虑到肝外胆管癌或胆囊癌患者接受放射治疗的风险和潜在获益。更多信息可在 www.asco.org/gastrointestinal-cancer-guidelines 获得。
