Radiation for R0?

Thanks again Eli. I checked the NCCN Guidelines Version 2.2012, Extra-2. It states “Consider fluoropyrimidine chemoradiation {f} (brachytherapy or external beam) followed by additional fluoropyrimidine or gemcitabine chemotherapy or Fluoropyrimidine based or gemcitabine based chemotherapy for positive regional lymph nodes {h}” I don’t know how to interpret that statement. Does consider apply to both part. As written it can be interpreted to read that “consider” doesn’t apply to the chemotherapy for positive regional lymph nodes and that “consider” only applies to the combination chemoradiation and chemotherapy for R1 or R2 or carcinoma in situ at margin, or positive regional nodes.

The paper you linked to, “Adjuvant treatment in biliary tract cancer: To treat or not to treat?” states the following under Guidelines and Current Clinical Practice. “The National Comprehensive Cancer Network (NCCN) guidelines recommend only observation or adjuvant CRT with concomitant fluoropyrimidine for patients with R0 margins or negative lymph nodes and adjuvant therapy with concurrent 5-fluorouracil-based CRT followed or not by additional fluoropyrimidine or gemcitabin-based regimens in patients with R1 margins or metastic lymph nodes.” So it appears here that the NCCN is recommending CRT with or without chemo for positive lymph nodes.

Also, it appears that the recommendation is to do radiation followed by chemo, whereas what the Ocshner oncologist proposes is to do chemo followed by radiation.

All very confusing to me.

Susie, thank you for your comments. It makes me wonder about second and additional opinions. I first ran into this when the Ochsner surgeon and his cancer board said to operate and the Southwest Medical Center and their cancer board said not to operate. We ended up getting a third opinion from a Baylor surgeon, who was the Ochsner’s surgeon’s mentor, and he said to operate, which I expected because of the mentor relationship. When we first met the Ochsner oncologist, she said that Ochsner was agressive and then rattled off about 5 other cancer centers which were either agressive or not. I kind of got the idea that this is tied in with their “do no harm” vow. The agressive doctors give me the impression that they will try almost anything to extend your life, even if what they are trying has not been statistically proven, whereas the non-agressive doctors don’t seem to want to take the chance that they may cause you harm.

As you say, in the end, it’s a personal choice, but I, like you, would prefer to get as much adjuvant therapy for my wife as they will give her.

Bruce