Resectable Cholangiocarcinoma: Reviewing the Role of Adjuvant Strategies

the Oncology Nurse Advisor take:

Cholangiocarcinoma, a rare group of neoplasms originating in the bile duct epithelium, represents only 3% of all gastrointestinal malignancies. Despite its rarity, both the incidence and mortality of cholangiocarcinoma have been rising. The only potentially curative option for this malignancy is surgical resection; however, the rates of resection are very low, thus resulting in a poor prognosis with a 5-year survival rate of approximately 5% to 10%. For the 10% to 40% of patients who are amenable to surgery, the 5-year survival rate increases to 25% to 30%.

Therefore, an evaluation of the benefit of adjuvant strategies following surgical resection to improve the curability rate is critical. A pooled analysis of 20 studies that included a total of 6712 patients demonstrated a nonsignificant survival benefit with adjuvant therapy compared with surgery alone, but those with node positivity or margins involved appeared to derive greater benefit from adjuvant therapy.

Findings from 2 randomized clinical trials have demonstrated effective chemotherapy regimens for the adjuvant setting: mitomycin C plus 5-fluorouracil (5-FU) followed by 5-FU until disease recurrence, and gemcitabine. It remains unclear whether single-agent or double chemotherapy is the optimal approach. Retrospective studies have also suggested that adjuvant radiotherapy may be useful.