John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Neoadjuvant and adjuvant treatment of biliary tract cancer, an update Volume 22, issue 4, Avril 2015


1 Centre Eugène Marquis, département d’oncologie médicale, CS 44229, 35 042 Rennes, France
2 CHU Pontchaillou, département de chirurgie digestive et hépatobiliaire, 35 033 Rennes, France
* Tirés à part

Biliary tract cancer is associated with a high risk of relapse following surgery. Major risk factors are lymph node invasion and R1-resection. However, even patients without any risk factors are indeed at significant risk of relapse, justifying to discuss perioperative treatment in all patients. Data are still at an insufficient level of evidence to routinely recommend such treatment. For locally advanced tumors, a downstaging neoadjuvant treatment would theoretically be beneficial, however, the only context where this is probably beneficial is the use of radiochemotherapy before liver transplantation in inoperable hilar cholangiocarcinoma. Regarding adjuvant treatment, the level of evidence is still too weak to allow recommendation for routine use. Most of the available data are retrospective. However, arguments based notably on a meta-analysis suggest that chemotherapy, but not radiotherapy, may be useful. Large scale randomized clinical trials (PRODIGE 12 in France, testing adjuvant GEMOX vs follow-up, and BILCAP in the United Kingdom, testing capecitabine vs follow-up) have recently completed accrual. A German study (ACTICCA-1), testing GemCis, is enrolling patients. Definitive results of these large randomized trials should be awaited to answer the question about the impact of adjuvant treatment in biliary tract cancer.