Alden M E, Waterman F M, Topham A K, Barbot D J, Shapiro M J, Mohiuddin M
Department of Radiation Oncology and Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Radiology. 1995 Nov;197(2):511-6. doi: 10.1148/radiology.197.2.7480704.
To define the criteria for resection and/or radiation therapy (RT) of extrahepatic bile duct cancer.
Of 81 patients with extrahepatic bile duct cancer treated from 1983 to 1992, those with proximal duct lesions (n = 56) underwent RT and/or resection or palliative care, and those with distal lesions (n = 25) underwent resection with or without RT. Follow-up was available 3-114 months (median, 28 months).
Patients with distal bile duct cancer lived longer than patients with proximal bile duct cancer (survival with Kaplan-Meier analysis, 53% vs 13% at 5 years, respectively, P < .01). Median survival in patients with proximal cancer after RT was more than double that without RT (17 months vs 6 months, respectively, regardless of stage [P = .01]); survival was not significantly different after resection. In patients with distal cancer, RT after resection made no significant difference in median survival (68 months).
Patients with proximal cancer should undergo primary RT, and expectations should be limited. Patients with distal cancer should undergo resection, and RT may not be needed.
明确肝外胆管癌的切除和/或放射治疗（RT）标准。
1983年至1992年治疗的81例肝外胆管癌患者中，近端胆管病变患者（n = 56）接受了RT和/或切除或姑息治疗，远端病变患者（n = 25）接受了有或无RT的切除术。随访时间为3 - 114个月（中位时间为28个月）。
远端胆管癌患者的生存期长于近端胆管癌患者（Kaplan-Meier分析的生存率，5年时分别为53%和13%，P <.01）。近端癌患者接受RT后的中位生存期比未接受RT的患者延长一倍多（分别为17个月和6个月，与分期无关[P =.01]）；切除术后生存率无显著差异。在远端癌患者中，切除术后RT对中位生存期无显著影响（68个月）。
近端癌患者应接受初始RT，预期应有限。远端癌患者应接受切除术，可能不需要RT。
