National Cancer Database analysis of adjuvant radiotherapy for biliary tract cancers

Biliary tract cancers (BTCs) have distinct tumor biology but share a poor prognosis, with 5-year survival rates of 5-19%. Surgical resection is the only potential cure, but recurrences are common. Analysis uing the National Cancer Database (2006-2018) investigated the role of adjuvant radiotherapy (RT) after resection of BTCs (patients with R2 resections or who received neoadjuvant therapy were excluded). Among 21,175 BTC patients, adjuvant RT provided a survival benefit for gall bladder cancer, especially in node-positive and R1-resected patients. For perihilar cholangiocarcinoma and distal cholangiocarcinoma, adjuvant RT improved outcomes of no therapy, but its benefit over chemotherapy was uncertain. No benefit was observed with adjuvant RT for intrahepatic cholangiocarcinoma. The authors conclude that these findings emphasize the need for tailored treatment strategies based on the specific type of BTC.