International Journal of Radiation Oncology*Biology*Physics
CLINICAL INVESTIGATIONSBenefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma☆
Introduction
Patients with main hepatic duct carcinoma often have advanced disease, making the treatment management of these patients extremely difficult. Although recent reports suggest that aggressive surgical approaches enhance the long-term survival of patients with advanced main hepatic duct carcinoma (Klatskin tumor) 1, 2, 3, 4, 5, the prognosis of these patients remains poor because of local-regional recurrence 4, 6. The eradication of post-resection tumor residue may lower the risk of local-regional recurrence. Therefore, many have advocated the use of adjuvant radiotherapy to eradicate post-resection tumor residue after resection 6, 7, 8, 9, 10, 11; however, the benefits of adjuvant radiotherapy remain controversial 12, 13.
In this retrospective study, we have evaluated the efficacy of combining radiation with radical resection in patients with locally advanced (Stage IVA) Klatskin tumor by examining operative mortality, morbidity, local control and metastasis, and long-term survival. The results of this evaluation should provide vital knowledge for deciding when and how adjuvant radiation should be applied.
Section snippets
Study population
Between October 1976 and April 1999, 102 patients with Klatskin tumor underwent resection at the Tsukuba University Hospital. The cancers were classified by the TNM/AJCC classification criteria (14) based on the pathologic findings. Sixty-three of the 102 patients were classified as having Stage IVA, and formed the study population. The histopathologic type of tumor in all 63 patients was adenocarcinoma. The Stage IVA carcinomas were classified into the following categories: T3, N0-2, and M0,
Treatment morbidity and mortality
Major complications were encountered in 10 patients. Sepsis and liver abscess were the most frequent complications, followed by multi-organ failure and liver failure. The rates of major complications and 30-day operative mortality were significantly (p < 0.05) higher in the resection alone group (28.6% and 9.5%) than in the adjuvant radiation group (9.5% and 0.0%). The overall 30-day operative mortality rate of patients with Stage IVA was 3.2% (2/63) (Table 4). Between postoperative days 41 and
Discussion
Several studies have reported the benefits of adjuvant radiotherapy after surgical resection of bile duct carcinoma; however, the effects of radiation on survival of patients with hilar bile duct carcinoma remains unclear 6, 10, 12, 15, 17, 18, 19, 20, 21. Despite the recent increase in the resection rate of advanced main hepatic duct carcinoma, improvement in the long-term survival rate has remained minimal 1, 2, 3, 4, 5, 22, 23, 24, 25. The usual tumor-related cause of death after surgical
Acknowledgements
The lead author acknowledges the late Professor Yoji Iwasaki, M.D., for encouraging us to treat patients with advanced disease.
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This study was supported in part by a grant-in-aid for Cancer Research (No. 8-4) from the Ministry of Health and Welfare of Japan.