Radiotherapy and chemotherapy for bile duct carcinomas

Surgical resection is the curative treatment for gallbladder carcinomas. The first recurrence of gallbladder carcinoma is usually distant. It is difficult to determine the benefit of adjuvant radiotherapy in the absence of randomised trials. The data available in the literature appear to show a benefit from concurrent chemoradiotherapy in cases of R1 and N+ disease. Resection is also the standard of care for the bile ducts. The rate of isolated recurrence is 60% following R0 resection. Two meta-analyses evaluating adjuvant chemoradiotherapy following curative resection of cholangiocarcinoma have shown a benefit in overall survival for adjuvant radiotherapy in cases of R1 resection and lymph node involvement. 3D conformal radiotherapy is the gold standard technique. The target volumes are the tumour or tumour bed and the lymph node regions. The dose is 45-50 Gy ± a boost of 15-20 Gy (2 Gy fractions). Capecitabine is considered the new standard for adjuvant therapy. Gemcitabine or fluoropyrimidines plus or minus radiotherapy is indicated from pT2, N+ or R1. Gemcitabine-cisplatin is the standard in palliative settings.