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    Patent Pending

    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
    1. Patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy for a duration of 6 months.
    2. 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].
    3. The Expert Panel agrees that the recommended dose of capecitabine may be determined by institutional and regional practices [Qualifying statement].
    Chemoradiotherapy
    1. Patients with extrahepatic cholangiocarcinoma or gallbladder cancer and a microscopically positive surgical margin resection (R1 resection) may be offered chemoradiotherapy.
    2. 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].
    3. 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].
    What do the icons mean?  
    Research PaperShroff RT, Kennedy EB, Bachini M, et al. Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline. J Clin Oncol. 2019;37(12):1015-1027.