Bile Duct Cancer, Its Survival and Local-Control after Radiotherapy

Purpose: This report retrospectively reviewed bile duct cancer cases at the authors’ institution over the past 17 years. Statistical methods have been employed to analyze overall survival and local-control rates of these cases, and to identify the correlations between different panameters such as the presenting symptoms and signs, surgical findings, radiotherapy (RT) dose, and the RT modality. Materials and Methods: Between 1985 and 2003, the Department of Radiation Oncology at the Chang Gung Memorial Hospital, Linkou, had 228 patients with bile duct cancer referred for RT. Only the 78 patients with no distant organ metastases who underwent treatment for localized biliary system lesions were included in this study. Five patients received intra-luminal RT (ILRT) alone, 15 had external beam RT (EBRT) plus ILRT, and 58 patients received EBRT alone. Statistical methods were employed to identify factors that affected overall survival and local-control rates. These factors include patients’ presenting symptoms and signs (jaundice and pain), a past history of hepatobiliary disease, pre-operative performance status (Karnofsky score), surgical findings (lymph node, perineural, and portal vein involvement), histological and pathological classification, CEA level, the radiation modality and the radiation dose. Results : The follow-up periods ranged from 1-160 months (median 17 months). The 78 patients had a 5-year overall survival rate of 11.3% after RT, and the median survival was 7.0 months (95% CI, 4.4- 9.9 months). Peri-neural and lymph node involvement, poor performance status, presence of pain and/ or jaundice, poorly differentiated histology, single RT modality and lower radiation doses were factors that correlated negatively with survival. The local control rate was most significantly affected by the presence of residual disease prior to RT. Conclusion: Higher doses RT offers a better survival to patients with bile duct cancers. The benefit of ILRT given alone remains unclear. Since residual disease appears to be critical for local control, complete resection of the tumor is essential; which reinforces the importance of early diagnosis of bile duct cancer.