Adjuvant chemo- or radiotherapy?

Thanks Percy – I had seen the BILCAP poster when Helen first posted it. I have read pretty much everything that is found on the internet about BILCAP – I just have to presume there is more evidence within the medical community which is not available for us laypersons to read!

Hi all,
I find a lot of the poster vague and a bit confusing really. Richard points out that the poster states ’41 (18%) patients had died within 24 months’ which should logically lead us to assume that 82% had not died within that time. This does not tie in with the graph.
I also find the statement ‘To detect an increase in 2 year survival from 20 to 32%’ confusing. I wonder where this evidence comes from – I have never read anywhere that 2 year survival of resected patients having no adjuvant therapy is 20%. It sounds more like the current 5 year survival for resected patients?

Not to put too fine a point on it, but I do not think the 2 year survival is as significant as ‘relapse free survival’. Richard is right, it would be interesting to compare the data but it cannot be considered significant at this point. It is important to remember that all patients have undergone a macroscopically complete resection – so we would really hope that a good proportion of these are still alive within 2 years – if they are cancer free is a very different question.

I suppose what Percy is saying is true of all cancer ‘there is no CURE’ – just more and more effective ways of removing it and minimising the likelihood of it returning. My personal attitude would have been to encourage my dad to take or do everything possible to stop it coming back. We were never offered radiation and the doctor said ‘what would we radiate? There’s nothing there’. Certainly the evidence Percy found would suggest the efficacy with margin positive patients.

Marion, thanks for that info about UK v US – I’ve sometimes wondered how different things would be if we could effectively just ask a doctor to prescribe something we wanted rather than being at the mercy of the NHS, but I just find it so difficult to imagine the accompanying financial/travel considerations that so many US patients encounter.

Kate

Richard…….Studies vary greatly. This particular study is focusing on overall survival of control arm (observation) vs. study arm (treatment) and the effect on 2-year survival. We can expect data to be released 2 years after begin of study.
The secondary study focuses on survival, relapse-free survival, toxicity, quality of life, and health economics.
We have seen studies to be halted in cases where the study arm demonstrates significant benefit over the control group. In such case the treatment will be applied immediately to the entire patient population. I don

Kate…I agree there are numerous differences in re: to clinical trials conducted in the UK vs. the US. There are some advantages in the UK over the US system though. In the UK medical institutions are required to conduct clinical trials hence you see quite a few studies initiated.
Accrual is relatively easy as numerous centers participate and considering the size of the UK vs. the US patients access to the medical facilities is easy and always cost free to the patient.
The above trial is conducted in 47 different centers in the UK. This is pretty significant. A similar trial conducted in the US would involve the majority of patients to incur travel expenses for which they are not reimbursed. And, more significantly US patients have to bear the cost of additional scans and testing not covered by their insurance carrier. (Medicare recipients excluded.) This however, is supposed to change as the government is requiring insurance companies to include clinical trial expenses. It can

Richard

Hi Richard,
I believe that the evidence is in the process of being compiled but unfortunately in this case the internet is not a fount of all knowledge.
You will notice that mostly the trials Marion mentioned are phase III. My dad’s oncologist points out that to get to that phase they must be based on some evidence, and has a strong conviction that the results will be positive.
Treatment varies wildly depending on where you live – in the UK we have a fairly strict protocol with few deviations. In the US there seems to be much more flexibility for doctors to make their own recommendations.
Kate

Hi,
there are retrospective series and small phrase Ii studies suggest superior outcomes for patients who receive EBRT radiation with or without concomitant chemotherapy or the combination of post-op 5FU plus brachytherapy after resection of cholangiocarcinoma.
for patient who are left with microscopically positive margins after resection,the main benefit of postoperative radiation therapy is a reduction in the rate of local recurrence.
in one study, margin positive resection patients increase their 5 year survival
rate if they received postoperative adjuvant EBRT (34 vs 14%).
In another study,46 cholangiocarcinoma patients(total pop.=128 patients of hepatibiliary ca) had 3D-CRT radiation plus FUDR intrahepetic artery infusion;60% of all patient were free of hepatic progreesion at 3 years.
In short ,receive postoperative adjuvant radiation treatment with or without chemo may prolong survival.

I know the above response may not answer the actual question that you had.
Should i wait until the CCA recur or do the preventive adjuvant radiation treatment as soon as possible?
MY answer is at least ,up to now, there are NO CURE for this disease;all the treatment plans are use to prolong or for palliative purposes;Recurrence is high in this disease(>65%). whether you monitor the disease progress every 3 months with scans like me or wait until the recurrence hit home. it is always a very difficult decision to make. Because there are no guaranteed for either way. But if you,like me, try the best we can, there will be no regrets when the time comes.
God bless