The role of adjuvant chemotherapy and radiotherapy for cholangiocarcinoma

Cholangiocarcinomas are rare cancers arising from the epithelia of the biliary tract. The only prospect of curative therapy is with surgery. However, relapse rates are high with five-year survival rates typically around 20-30%. Involved resection margins and spread to local lymph nodes are associated with a higher risk of relapse. Such poor outcomes provide a rationale for adjuvant strategies to improve survival. However, there is little randomised data to support the use of adjuvant therapy; the available evidence base is based mostly on retrospective case series and results are often conflicting. This review evaluates the available evidence. Adjuvant therapy may be considered on an individual patient basis after discussion of the limitations of our knowledge. The results of prospective, randomised clinical trials of adjuvant therapy are eagerly awaited. Progress will require collaboration of basic science and clinical oncology and the execution of well-designed clinical trials.