Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy

The role of adjuvant chemoradiation therapy (CT/XRT) in the treatment of ch olangiocarcinoma. is controversial. We undertook this study to determine wh ether CT/XRT is appropriate after resection of cholangiocarcinomas. One hun dred ninety-two patients with cholangiocarcinomas were treated from 1988 to 1999. After resection, patients were assigned a stage (TNM) and were strat ified by location of the tumor as intrahepatic, perihilar, and distal tumor s. Data are presented as mean standard deviation. Of 192 patients 92 (48%) underwent resections of cholangiocarcinomas. Thirty-four patients had liver resections, 25 had bile duct resections, and 33 underwent pancreaticoduode nectomies. Thirty-four patients had adjuvant CT/XRT, three had adjuvant che motherapy, four had neoadjuvant CT/XRT, and 50 had no radiation or chemothe rapy. Mean survival of resected patients with adjuvant CT/XRT was 42 +/- 37 .0 months and without CT/XRT it was 29 +/- 24.5 months (P=0.07). Mean survi val of patients with distal tumors receiving or not receiving Ct/XRT was 41 +/- 21.8 versus 25 +/- 20.1 months, respectively, (P=0.04). Adjuvant chemo radiation improves survival after resection for cholangiocarcinoma (P=0.07) particularly in patients undergoing resection for distal tumors (P=0.04). Benefits of adjuvant CT/XRT are apparent when stratified by location of cho langiocarcinomas rather than staging.