Clinical Research Papers:

Impact of radiation dose in postoperative radiotherapy after R1 resection for extrahepatic bile duct cancer: long term results from a single institution

Byoung Hyuck Kim _, Eui Kyu Chie, Kyubo Kim, Jin-Young Jang, Sun Whe Kim, Do-Youn Oh, Yung-Jue Bang and Sung W. Ha

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Oncotarget. 2017; 8:78076-78085. https://doi.org/10.18632/oncotarget.17368

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Byoung Hyuck Kim1,4, Eui Kyu Chie1, Kyubo Kim5, Jin-Young Jang2, Sun Whe Kim2, Do-Youn Oh3, Yung-Jue Bang3 and Sung W. Ha1

1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea

2 Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

3 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

4 Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, Republic of Korea

5 Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea

Correspondence to:

Eui Kyu Chie, email:

Keywords: extrahepatic bile duct cancer, R1 resection, postoperative radiotherapy, radiation dose

Received: September 18, 2016 Accepted: April 10, 2017 Published: April 21, 2017


Purpose: This study was conducted to evaluate the impact of radiation dose after margin involved resection in patients with extrahepatic bile duct cancer.

Methods: Among the 251 patients who underwent curative resection followed by adjuvant chemoradiotherapy, 86 patients had either invasive carcinoma (n = 63) or carcinoma in situ (n = 23) at the resected margin. Among them, 54 patients received conventional radiation dose (40-50.4 Gy) and 32 patients received escalated radiation dose (54-56 Gy).

Results: Escalated radiation dose was associated with improved locoregional control (5yr rate, 73.8% vs. 47.1%, p = 0.069), but not disease-free survival (5yr rate, 43.4% vs. 32.6%, p = 0.490) and overall survival (5yr rate, 40.6% vs. 29.6%, p = 0.348). In multivariate analysis for locoregional control, invasive carcinoma at the margin (HR 2.957, p = 0.032) and escalated radiation dose (HR 0.394, p = 0.047) were independent prognostic factors. No additional gastrointestinal toxicity was observed in escalated dose group.

Conclusions: Delivery of radiation dose ≥ 54 Gy was well tolerated and associated with improved locoregional control, but not with overall survival after margin involved resection. Further validation study is warranted.

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