Does radiotherapy still have a role in unresected biliary tract cancer? - PubMed (original) (raw)

Does radiotherapy still have a role in unresected biliary tract cancer?

Erqi L Pollom et al. Cancer Med. 2017 Jan.

Abstract

The benefits of radiotherapy for inoperable biliary tract cancer remain unclear due to the lack of randomized data. We evaluated the impact of radiotherapy on survival in elderly patients using the SEER-Medicare database. Patients in the SEER-Medicare database with inoperable biliary tract tumors diagnosed between 1998 and 2011 were included. We used multivariate logistic regression to evaluate factors associated with treatment selection, and multivariate Cox regression and propensity score matching to evaluate treatment selection in relation to subsequent survival. Of the 2343 patients included, 451 (19%) received radiotherapy within 4 months of diagnosis. The use of radiotherapy declined over time, and was influenced by receipt of chemotherapy and patient age, race, marital status, poverty status, and tumor stage and type. Median survival was 9.3 (95% CI 8.7-9.7) months among patients who did not receive radiation and 10.0 (95% CI 9.1-11.3) months among those who received radiation, conditional on having survived 4 months. In patients who received chemotherapy (n = 1053), receipt of radiation was associated with improved survival, with an adjusted hazard ratio of 0.82 (95% 0.70-0.97, P = 0.02). In patients who did not receive chemotherapy (n = 1290), receipt of radiation was not associated with improved survival, with an adjusted hazard ratio of 1.09 (95% 0.91-1.30, P = 0.34). Propensity-scored matched analyses showed similar results. Despite the survival benefit associated with the addition of radiotherapy to chemotherapy, the use of radiation for unresectable biliary tract cancers has declined over time.

Keywords: Chemoradiation; SEER-Medicare; cholangiocarcinoma; elderly; gallbladder.

© 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Kaplan–Meier survival curves of those who received radiation versus those who did not receive radiation in the no chemotherapy cohort.

Figure 2

Figure 2

Kaplan–Meier survival curves of those who received radiation versus those who did not receive radiation in the chemotherapy cohort.

Figure C1

Figure C1

Distribution of propensity scores of radiation (top) and no radiation groups (bottom) (a) before matching in no chemotherapy group, (b) before matching in chemotherapy group, (c) after matching in no chemotherapy group and (d) after matching in chemotherapy group.

References

    1. Hezel, A. F. , and Zhu A. X.. 2008. Systemic therapy for biliary tract cancers. Oncologist 13:415–423. - PubMed
    1. Anderson, C. D. , Pinson C. W., Berlin J., and Chari R. S. 2004. Diagnosis and treatment of cholangiocarcinoma. Oncologist 9:43–57. - PubMed
    1. Nakeeb, A. , Pitt H. A., Sohn T. A., Coleman J., Abrams R. A., Piantadosi S., et al. 1996. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann. Surg. 224:463–473; discussion 473–5. - PMC - PubMed
    1. Park, J. , Kim M. H., Kim K. P., Park do H., Moon S. H., Song T. J., et al. 2009. Natural history and prognostic factors of advanced cholangiocarcinoma without surgery, chemotherapy, or radiotherapy: a large‐scale observational study. Gut. Liv. 3:298–305. - PMC - PubMed
    1. Valle, J. , Wasan H., Palmer D. H., Cunningham D., Anthoney A., Maraveyas A., et al. 2010. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N. Engl. J. Med. 362:1273–1281. - PubMed

MeSH terms

LinkOut - more resources