Adjuvant Therapy for Resected Biliary Tract Cancer (beta)

Based on guidelines from the American Society of Clinical Oncology.

Strength

Strong recommendation

Moderate recommendation

Weak recommendation

N/A

Evidence

High quality evidence

Intermediate quality evidence

Low quality evidence

Insufficient evidence

N/A

Treatment

Adjuvant Capecitabine Chemotherapy

Patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy for a duration of 6 months.
Moderate recommendation
Intermediate quality evidence
In the BILCAP (Adjuvant Capecitabine for Biliary Tract Cancer) phase III randomized controlled trial, capecitabine was delivered at a dose of 1,250 mg/m² twice a day on treatment days 1 to 14 of a 3-week cycle for 24 weeks (eight cycles) [Qualifying statement].
N/A
N/A
The Expert Panel agrees that the recommended dose of capecitabine may be determined by institutional and regional practices [Qualifying statement].
N/A
N/A

Chemoradiotherapy

Patients with extrahepatic cholangiocarcinoma or gallbladder cancer and a microscopically positive surgical margin resection (R1 resection) may be offered chemoradiotherapy.
Moderate recommendation
Low quality evidence
A shared decision-making approach is recommended, considering the risk of potential harm and potential for benefit associated with radiation therapy for patients with extrahepatic cholangiocarcinoma or gallbladder cancer [Qualifying statement].
N/A
N/A
The Expert Panel notes that in the SWOG0809 prospective single-arm trial of chemoradiotherapy, radiation was delivered at a dose of 45 Gy to regional lymphatics and 54 to 59.4 Gy to the tumor bed. However, at this time, the evidence base is not sufficiently well developed to make a recommendation for optimal dosing of radiation therapy in the context of chemoradiation therapy [Qualifying statement].
N/A
N/A