CARCINOMA OF THE EXTRAHEPATIC BILE-DUCTS - THE UNIVERSITY-OF-CALIFORNIA AT SAN-FRANCISCO EXPERIENCE

Objective The authors investigated the combined experience of a single institution in treating bile duct carcinoma during the modern era. Su mmary Background Data Bile duct carcinomas are notoriously difficult t o cure, with locoregional recurrence the rule, even after radical rese ction. Adjuvant efforts have included various radiation modalities, wi th limited success. Recently, charged-particle radiotherapy has also b een used in these patients. Methods The authors performed a retrospect ive chart analysis of 129 patients with bile duct adenocarcinomas trea ted between 1977 and 1987 through the University of California at San Francisco, including 22 patients treated at Lawrence Berkeley Laborato ry with the charged particles helium and neon. The minimum follow-up w as 5 years. Survival, outcome, and complication results were analyzed. Results Sixty-two patients were treated with surgery alone (S), 45 pa tients received conventional adjuvant x-ray radiotherapy (S + X), and 22 were treated with charged particles (S + CP). The median survival t imes were 6.5, 11, and 14 months, respectively, for the entire group, and 16, 16, and 23 months in patients treated with curative intent. Th ere was a survival difference in patients undergoing total resection c ompared with debulking (p = 0.05) and minor resections (p = 0.0001). P atients with microscopic residual disease had increased median surviva l times when they were treated with adjuvant irradiation, most markedl y after CP (p = 0.0005) but also with conventional X (p = 0.0109). Pat ients with gross residual disease had a less marked but still statisti cally significant extended survival (p = 0.05 for S + X and p = 0.0423 for S + CP) after irradiation. Conclusions The mainstay of bile duct carcinoma management was maximal surgical resection in these patients. Postoperative radiotherapy gave patients with positive microscopic ma rgins a significant survival advantage and may be of value in selected patients with gross disease.