Editorial
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 7, 2012; 18(21): 2591-2596
Published online Jun 7, 2012. doi: 10.3748/wjg.v18.i21.2591
Adjuvant treatment in biliary tract cancer: To treat or not to treat?
Stefano Cereda, Carmen Belli, Michele Reni
Stefano Cereda, Carmen Belli, Michele Reni, Department of Oncology, San Raffaele Scientific Institute, 20132 Milan, Italy
Author contributions: Reni M conceived the paper and critically reviewed the data and the final version; Belli C contributed to the analysis and interpretation of data; Cereda S drafted the article and revised it critically for important intellectual content; all authors approved the final version.
Correspondence to: Michele Reni, MD, Department of Oncology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. reni.michele@hsr.it
Telephone: +39-2-26437644 Fax: +39-2-26437625
Received: October 29, 2011
Revised: April 5, 2012
Accepted: April 12, 2012
Published online: June 7, 2012
Abstract

Biliary tract cancer is a rare malignant tumor. There is limited knowledge about biology and natural history of this disease and considerable uncertainty remains regarding its optimal diagnostic and therapeutic management. The role of adjuvant therapy is object of debate and controversy. Although resection is identified as the most effective and the only potentially curative treatment, there is no consensus on the impact of adjuvant chemotherapy and/or radiotherapy on the high incidence of disease recurrence and on survival. This is mainly due to the rarity of this disease and the consequent difficulty in performing randomized trials. The only two prospectively controlled trials concluded that adjuvant chemotherapy did not improve survival. Most of the retrospective trials, which had limited sample size and included heterogeneous patients population and non-standardized therapies, suggested a marginal benefit of chemoradiotherapy in reducing locoregional recurrence and an uncertain impact on survival. Well-designed multi-institutional randomized trials are necessary to clarify the role of adjuvant therapy. Two ongoing phase III trials may provide relevant information.

Keywords: Biliary tract cancer; Adjuvant therapy; Chemotherapy; Chemoradiation; Surgery