NSCLC im Stadium II: Strahlentherapie und Einsatz von Chemotherapie bei nicht operablen Patienten

2020 ◽  
Vol 8 (3) ◽  
pp. 146-147
Author(s):  
Miriam Möller ◽  
Wolfgang Schütte
Keyword(s):  
Weight Loss ◽  
Surgical Resection ◽  
Smoking Status ◽  
Primary Outcome Measure ◽  
Concurrent Chemotherapy ◽  
Stage Ii ◽  
Curative Intent ◽  
Curative Therapy ◽  
Ecog Ps ◽  
The Impact

Objectives: Curative intent therapy of stage II NSCLC may include surgical resection or definitive radiotherapy. Primary management with surgery or radiotherapy may be influenced by patient and disease characteristics. We sought to perform a comparison of patients receiving surgery or radical radiation therapy as their curative treatment, and explore the impact of known prognostic factors on outcome. Materials and methods: A retrospective review was completed of all patients with stage II NSCLC referred to the BC Cancer Agency from 2005 to 2012. Cases were filtered to identify those receiving curative intent therapy including surgery or radiotherapy. Information was collected on known prognostic and predictive factors. The primary outcome measure was overall survival. We compared survival among patients receiving curative intent radiotherapy versus surgical intervention. Results: A total of 535 patients were referred. Of these, 245 (46%) received curative intent surgery, 132 (25%) curative intent radiotherapy, and 158 (30%) did not receive curative therapy. There were significant differences between cohorts with respect to median age, histology, ECOG PS, smoking status, and weight loss. Median OS was significantly different between cohorts: 61.4 m surgery, 26.5 m curative RT, and 13.1 m non-curative therapy. In a case-matched analysis, median OS remained superior for surgery at 101.6 m vs 28.1 m for curative RT. In a multivariate analysis, ECOG PS, weight loss, and treatment cohort all influenced survival. Among patients receiving curative intent radiotherapy, the use of concurrent chemotherapy and RT dose > = 60Gy were associated with improved outcomes. Conclusions: Among patients with stage II NSCLC, many are unable to undergo standard of care surgical resection. Radiotherapy provides an inferior yet still curative option in the management of inoperable patients. Further work is needed to optimize outcomes in this population.

CPCNP en estadio II: radioterapia y uso de quimioterapia en pacientes inoperables

2020 ◽  
pp. 61-62
Author(s):  
Miriam Möller ◽  
Wolfgang Schütte
Keyword(s):  
Weight Loss ◽  
Surgical Resection ◽  
Smoking Status ◽  
Primary Outcome Measure ◽  
Concurrent Chemotherapy ◽  
Stage Ii ◽  
Curative Intent ◽  
Curative Therapy ◽  
Ecog Ps ◽  
The Impact

<b><i>Objectives:</i></b> Curative intent therapy of stage II NSCLC may include surgical resection or definitive radiotherapy. Primary management with surgery or radiotherapy may be influenced by patient and disease characteristics. We sought to perform a comparison of patients receiving surgery or radical radiation therapy as their curative treatment, and explore the impact of known prognostic factors on outcome. <b><i>Materials and methods:</i></b> A retrospective review was completed of all patients with stage II NSCLC referred to the BC Cancer Agency from 2005 to 2012. Cases were filtered to identify those receiving curative intent therapy including surgery or radiotherapy. Information was collected on known prognostic and predictive factors. The primary outcome measure was overall survival. We compared survival among patients receiving curative intent radiotherapy versus surgical intervention. <b><i>Results:</i></b> A total of 535 patients were referred. Of these, 245 (46%) received curative intent surgery, 132 (25%) curative intent radiotherapy, and 158 (30%) did not receive curative therapy. There were significant differences between cohorts with respect to median age, histology, ECOG PS, smoking status, and weight loss. Median OS was significantly different between cohorts: 61.4 m surgery, 26.5 m curative RT, and 13.1 m non-curative therapy. In a case-matched analysis, median OS remained superior for surgery at 101.6 m vs 28.1 m for curative RT. In a multivariate analysis, ECOG PS, weight loss, and treatment cohort all influenced survival. Among patients receiving curative intent radiotherapy, the use of concurrent chemotherapy and RT dose ≥ 60 Gy were associated with improved outcomes. <b><i>Conclusions:</i></b> Among patients with stage II NSCLC, many are unable to undergo standard of care surgical resection. Radiotherapy provides an inferior yet still curative option in the management of inoperable patients. Further work is needed to optimize outcomes in this population.

scholarly journals P-OGC58 Preoperative Enteral Feeding in Patients with Oesophagogastric Cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Cathy White ◽  
Mayilone Arumugusamy ◽  
William Robb
Keyword(s):  
Weight Loss ◽  
Enteral Feeding ◽  
Patient Flow ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Jejunostomy Tube ◽  
Curative Intent ◽  
Additional Support ◽  
The Impact

Abstract Background Patients with Oesophagogastric (OG) cancer undergoing multimodal treatment have a higher risk for progressive decline in their nutritional status. Our centre has seen increased numbers of patients using jejunostomy and gastrostomy tube feeding as an additional support during neoadjuvant chemotherapy and radiotherapy (nCRT).  This audit aimed to evaluate the processes surrounding and the impact of this intervention. Methods A retrospective review of 2019 medical records.  Patients with OG cancer for treatment with curative intent that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Results 14 patients were admitted for elective feeding tube insertion in 2019. On admission N = 10 patients (71%) had clinically severe weight loss (defined as ≥ 10% in 6 months, or ≥ 7.5% in 3 months or ≥ 5% in 1 month).  Four (29%) had a dietetic assessment pre admission, with 1 patient (7%) trained on home enteral nutrition pre admission. Conclusions This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this.   For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.

Approach to the Older Patient with Stage II/III Colorectal Cancer: Who Should Get Curative-Intent Therapy?

2013 ◽  
pp. 163-168
Author(s):  
Erika Ramsdale ◽  
Hanna Sanoff ◽  
Hyman Muss
Keyword(s):  
Colorectal Cancer ◽  
Older Adults ◽  
Older Patients ◽  
Performance Status ◽  
Locally Advanced ◽  
Eastern Cooperative Oncology Group ◽  
Stage Ii ◽  
Ecog Performance Status ◽  
Curative Intent ◽  
Curative Therapy

The majority of new colorectal cancer diagnoses occur in adults 65 and older a rapidly growing segment of the U.S. population. Older adults are a markedly heterogeneous group, and although recent clinical trials in locally advanced colorectal cancer have incorporated limited numbers of older patients, the data can not be generalized to most older patients. In particular, patients who are not “fit”—those with poor functional reserve, major comorbidities, or who otherwise meet criteria for frailty or “prefrailty”—are poorly represented in published trials. Population-based data demonstrate that older adults are much less likely to be treated in the adjuvant or neoadjuvant settings for stage II/III colorectal cancer, but it is unclear what the basis should be for withholding potentially curative therapy. Age and Eastern Cooperative Oncology Group (ECOG) performance status (PS) are frequently used to determine eligibility for treatment, but data increasingly suggest these are inadequate; the emerging definition of a spectrum of “fit” to “frail” older patients may provide additional guidance. Available data suggest that fit older patients may benefit as much from curative-intent therapy as younger patients. For frail or vulnerable (prefrail) patients, on the other hand, the benefit must be carefully weighed against the risk of toxicity and competing risks from their comorbidities. Life expectancy and patient preferences should always be elucidated. Geriatrician comanagement may be helpful in determining priorities, providing a comprehensive assessment, and modifying competing risk factors. Even many vulnerable or frail patients can successfully complete (and derive benefit from) carefully considered treatment regimens.

Systematic review of histamine type 2 receptor antagonists as an adjunct to curative surgical resection in gastrointestinal malignancies

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15085-e15085
Author(s):  
S. Deva ◽  
M. B. Jameson
Keyword(s):  
Systematic Review ◽  
Cancer Patients ◽  
Surgical Resection ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Tumor Infiltrating Lymphocytes ◽  
Cochrane Collaboration ◽  
Curative Intent ◽  
Gastrointestinal Malignancies ◽  
The Impact

e15085 Background: H2RAs have induced regression in a number of malignancies. The mechanisms that may contribute to this effect include inhibition of T-suppressor lymphocytes, increased tumor infiltrating lymphocytes and blockade of histamine-induced tumor proliferation and angiogenesis. Unique to cimetidine is its ability to inhibit vascular endothelial expression of the cell adhesion molecule E-selectin, to which many GI tumor cells adhere via carbohydrate antigen ligands. The optimal use of H2RAs in cancer patients could therefore be as adjuvant therapy rather than for metastatic disease. Methods: This systematic review examines the impact of H2RAs on the overall survival of patients when used as an adjunct to curative surgical resection for a GI malignancy. Using a sensitive search strategy, randomized controlled trials were identified in relevant databases. Criteria for study selection included: patients with colorectal or gastric cancer surgically resected with curative intent; H2RAs used i) at any dose, ii) for any length of time, iii) with any other treatment modality and iv) in the pre-, peri- or post-operative period. The results were stratified for both the type of malignancy and the H2RA used and analyzed by meta-analysis using Cochrane Collaboration software. Results: Of 350 trials identified, 8 were eligible for inclusion and had sufficient data for analysis, including a total of 1461 patients. Meta-analysis revealed a risk ratio for mortality of 0.86 (95% CI 0.76–0.99, p = 0.03) for patients randomised to H2RAs. Trials of colorectal cancer patients where cimetidine was the H2RA being evaluated demonstrated a significant survival advantage, risk ratio 0.53 (95% CI 0.33–0.84, p = 0.007). All other subgroups demonstrated a non-significant trend favouring H2RAs. Conclusions: H2RAs, and cimetidine in particular, appear to confer a survival benefit when given as an adjunct to curative surgical resection of GI cancers. The trial designs were heterogeneous and further large studies are warranted. No significant financial relationships to disclose.

Comorbidity and the receipt of curative therapy for favorable-risk prostate cancer prior to and following the publication of PIVOT.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 17-17
Author(s):  
Stephen A. Mihalcik ◽  
Ming-Hui Chen ◽  
Michelle H. Braccioforte ◽  
Brian Joseph Moran ◽  
Anthony V. D'Amico
Keyword(s):  
Prostate Cancer ◽  
Low Risk ◽  
Curative Treatment ◽  
Intermediate Risk ◽  
Curative Intent ◽  
Curative Therapy ◽  
Risk Indices ◽  
Before And After ◽  
Cancer Intervention ◽  
The Impact

17 Background: On July 19, 2012, the Prostate Cancer Intervention versus Observation Trial (PIVOT) was published and reported that after a median follow up of 10 years, radical prostatectomy neither improved overall survival nor reduced prostate cancer (PC)-specific mortality in men with low-risk PC compared to watchful waiting. However, the trial’s applicability may be somewhat limited by the participants’ poorer-than-average overall health. This study aimed to evaluate the impact of the PIVOT by assessing practice patterns before and after its publication. Methods: Between October 1997 and May 2013, 6,818 men with low-risk (n = 5,081, 74.5%) or favorable intermediate-risk (N = 1,737, 25.5%) PC were treated with curative intent at the Chicago PC Foundation. We compared the proportions of these men with ≥2, 1, or 0 comorbid conditions, restricted to myocardial infarction, congestive heart failure, diabetes mellitus, and coronary artery disease. We assessed for a trend in these proportions by time tertile prior to the PIVOT’s publication and compared them one month following PIVOT to the final pre-publication time tertile. Results: Of 6,818 men treated with curative intent, 5,208 (76.5%), 1,307 (19.2%), and 293 (4.3%) had 0, 1, and ≥2 comorbidities, respectively. Prior to PIVOT, the proportion of men with the greatest comorbidity (≥2) increased by time tertile (3.5% vs. 4.2% vs. 5.4%; p = 0.002), while 1 month following publication, there was a decline in the proportion of men with the highest degree of comorbidity (5.4% vs. 2.9%; p = 0.05). In addition to the drop in men with greatest comorbidity, men treated following the publication of the PIVOT were also younger (median age 65.7 vs. 66.8 years; p = 0.04), more likely to be black or Hispanic (24.7% vs. 17.4%; p = 0.003), and more likely to have favorable intermediate than low-risk PC (36.1% vs. 28.4%; p = 0.007). Conclusions: Following the publication of the PIVOT, men with low or favorable intermediate-risk PC whose health was poorer than the national average were less likely to undergo curative treatment, whereas men at higher risk for harboring occult high grade PC despite favorable-risk indices were more likely to undergo curative treatment.

Evaluation of complete pathological remission rates in surgically resected MSI-high metastatic colorectal cancers (mCRC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15046-e15046
Author(s):  
Kaysia Ludford ◽  
Romain Cohen ◽  
Wai Chin Foo ◽  
Jane V Thomas ◽  
Yann Parc ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Primary Tumor ◽  
Residual Tumor ◽  
Pathological Response ◽  
Cancer Center ◽  
Clinical Activity ◽  
Complete Pathological Response ◽  
Curative Intent ◽  
Surgical Specimen ◽  
The Impact

e15046 Background: Immune checkpoint inhibition (ICKi) for mCRC with deficient mismatch repair (dMMR) or microsatellite instability high (MSI-H) demonstrates a high clinical activity rate that appears durable. The impact of immunotherapy on pathological tumor response in dMMR/MSI-H CRC is unknown. Our aim was to assess the pathological response and clinical outcomes following surgical resection in dMMR/MSI-H CRC patients who undergo surgical resection following immunotherapy. Methods: All dMMR/MSI-H mCRC patients treated with anti-PD1/L1 based ICKi between November 2016 and December 2018 at MD Anderson Cancer Center, Houston, Texas and Saint-Antoine Hospital, Paris, France who then underwent surgical resection were included in this retrospective analysis. MSI-H status was determined by ICH in 4 patients and by PCR and ICH in 8 patients. The primary outcome was pathological response in resected surgical specimens following at least 1 cycle of ICKi. Complete pathological response was defined as the absence of residual cancer cells in the surgical specimen. Results: 12 patients (median age at diagnosis 45 years (range 30-70); 10 germline mutations,2 sporadic) of 111 who received ICKi (11%) underwent surgical resection of primary tumor only (n = 5), metastases only (n = 6) or both primary tumor and metastases (n = 1). 42% of patients received PD1 combined with CTLA4 iCKi while 58% received PD1 monotherapy. The median time from ICKi introduction to surgery was 12 months (range 2-28). Prior to surgery 1 patient had complete radiographic response while 11 patients had residual tumor on imaging. 9 surgeries were done with curative intent and 3 with palliative intent. 11 patients achieved pCR while 1 achieved near pCR with rare viable tumor remaining (prior ICKi duration was 2 months). Median follow-up from surgery is 7 months. No patients have progressed following surgical resection. Conclusions: Complete pathological response is achievable with ICKi for dMMR/MSI-H mCRC. For these patients this data supports the curative potential of anti-PD1 based therapy and suggests that residual radiographic tumor may not require surgical resection following response to anti-PD1 based therapy.

scholarly journals Weight loss and risk reduction of obesity-related outcomes in 0.5 million people: evidence from a UK primary care database

2021 ◽  
Author(s):  
Christiane Lundegaard Haase ◽  
Sandra Lopes ◽  
Anne Helene Olsen ◽  
Altynai Satylganova ◽  
Volker Schnecke ◽  
...  
Keyword(s):  
Weight Loss ◽  
Smoking Status ◽  
High Body Mass Index ◽  
Baseline Period ◽  
Sleep Apnoea ◽  
Practice Research ◽  
Dietary Advice ◽  
Clinical Practice Research Datalink ◽  
Cvd Risk ◽  
The Impact

AbstractHigh body mass index (BMI) is known to be associated with various conditions, including type 2 diabetes (T2D), osteoarthritis, cardiovascular disease (CVD) and sleep apnoea; however, the impact of intentional weight loss on the risk of these and other outcomes is not well quantified. We examined the effect of weight loss on ten selected outcomes in a population from the UK Clinical Practice Research Datalink (CPRD) GOLD database. Included individuals were >18 years old at the index date (first BMI value between January 2001 and December 2010). They were categorised by their weight pattern between year 1 post-index and year 4 post-index (baseline period) as having stable weight (−5% to +5%) or weight loss (−25% to −10%, plus evidence of intervention or dietary advice to confirm intention to lose weight). For inclusion, individuals also required a BMI of 25.0–50.0 kg/m2 at the start of the follow-up period, during which the occurrence of ten obesity-related outcomes was recorded. Cox proportional hazard models adjusted for BMI, comorbidities, age, sex and smoking status were used to estimate relative risks for weight loss compared with stable weight. Individuals in the weight-loss cohort had median 13% weight loss. Assuming a BMI of 40 kg/m2 before weight loss, this resulted in risk reductions for T2D (41%), sleep apnoea (40%), hypertension (22%), dyslipidaemia (19%) and asthma (18%). Furthermore, weight loss was associated with additional benefits, with lower risk of T2D, chronic kidney disease, hypertension and dyslipidaemia compared with maintaining the corresponding stable lower BMI throughout the study. This study provides objective, real-world quantification of the effects of weight loss on selected outcomes, with the greatest benefits observed for the established CVD risk factors T2D, hypertension and dyslipidaemia.

scholarly journals Does Sex Influence the Impact That Smoking, Treatment Interruption and Impaired Pulmonary Function Have on Outcomes in Limited Stage Small Cell Lung Cancer Treatment?

2005 ◽  
Vol 12 (5) ◽  
pp. 245-250 ◽  
Author(s):  
Gregory MM Videtic ◽  
Pauline T Truong ◽  
Robert B Ash ◽  
Edward W Yu ◽  
Walter I Kocha ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Smoking Status ◽  
Multivariable Analysis ◽  
Concurrent Chemotherapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Limited Stage ◽  
The Impact

PURPOSE: To look for survival differences between men and women with limited stage small cell lung cancer (LS-SCLC) by examining stratified variables that impair treatment efficacy.METHODS: A retrospective review of 215 LS-SCLC patients treated from 1989 to 1999 with concurrent chemotherapy-radiotherapy modelled on the 'early-start' thoracic radiotherapy arm of a National Cancer Institute of Canada randomized trial.RESULTS: Of 215 LS-SCLC patients, 126 (58.6%) were men and 89 (41.4%) were women. Smoking status during treatment for 186 patients (86.5%) was: 107 (58%) nonsmoking (NS) (76 [71%] male [M]; 31 [29%] female [F]) and 79 (42%) smoking (S) (36 M [46%]; 43 F [54%]) (continuing-to-smoke F versus M, P=0.001). Fifty-six patients (26%) had radiotherapy interruptions (RTI) during chemotherapy-radiotherapy because of toxicity. Radiotherapy breaks were not associated with sex (P=0.95). Survival by sex and smoking status at two years was: F + NS = 38.7%; F + S = 21.6%; M + NS = 22.9%; and M + S = 9.1% (P=0.0046). Survival by sex and RTI status at two years was: F + no RTI = 32.4%; F + RTI = 23.6%; M + no RTI = 23.0%; and M + RTI = 3.8% (P=0.0025). Diffusion capacity for carbon monoxide (DLCO) was recorded for 86 patients (40%) and median survival by sex and DLCO was F = 16.7 months and M = 12.1 months for a DLCO less than 60%; and for a DLCO 60% or more, F = 15.1 months and M = 15.3 months. First relapses were recorded in 132 cases (61%), with chest failure in men (45%) greater than for women (35%) and cranial failure rates similar between sexes (48%). Upon multivariable analysis, continued smoking was the strongest negative factor affecting survival.CONCLUSIONS: In LS-SCLC, women overall do better than men, with or without a negative variable. The largest quantifiable improvement in survival for women came from smoking cessation, and for men from avoidance of breaks during treatment.

Effect of nutritional status and support on survival in esophageal cancer patients undergoing combined modality therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20641-e20641
Author(s):  
J. P. Plastaras ◽  
J. C. Haynes ◽  
R. Mick ◽  
L. M. Hertan ◽  
A. I. Urdaneta ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Cox Regression ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Nutritional Supplements ◽  
Curative Intent ◽  
Cox Regression Analysis ◽  
The Impact

e20641 Background: Baseline nutritional status is associated with clinical outcomes in esophageal cancer. Moreover, nutritional support during chemoradiation has been shown to improve outcomes in other disease sites. This retrospective study evaluated the impact of nutritional interventions and baseline nutritional status on outcomes in patients (pts) with locally advanced esophageal cancer. Methods: A retrospective review was performed of 132 pts treated with curative intent using radiation (RT) between 1986 and 2007 at the Hospital of the University of Pennsylvania. The median age of the population was 60 years (range: 33–86). Esophagectomy was performed in 70%, with adjuvant RT in 60% and neoadjuvant RT in 40%. Concurrent chemotherapy was given to 85% of the group. Nutritional counseling was provided to 83% of pts. During RT, oral or enteral nutritional supplements were provided to 77% of pts and intravenous fluids (IVF) were given to 38%. Median follow-up was 14.1 months. Results: Median survival from end of radiation was 1.5 yrs. Median absolute and percentage weight loss during RT were 6.2 lbs and 3.8%, respectively. Median percentage decrease in hemoglobin and albumin were 5.7% and 9.1%, respectively. Univariable Cox regression analysis demonstrated a statistically significant association between weight loss of ≥5 lbs during RT and worse survival (HR 1.74, 95% CI 1.09 - 2.79, p=0.02). Decrease in hemoglobin of 5% or more (HR 1.22, 95% CI 0.59 - 2.54) and decrease in albumin of 10% or more (HR 1.09, 95% CI 0.48 - 2.48) were not associated with survival. Patients who received only nutritional supplements during RT survived significantly longer (p=0.03) than pts who received IVF regardless of nutritional supplementation (HR 2.12, 95% CI 1.12 - 4.01) or pts who received neither nutritional supplements nor IVF (HR 1.8, 95% CI 1.03 - 3.14). Conclusions: Weight loss during RT predicted for worse survival. Nutritional factors before and during RT may be important in outcomes in patients with esophageal cancer and may be modifiable. The use of IVF may be a potential indicator of worse prognosis. Future prospective studies should consider these factors in trial design. No significant financial relationships to disclose.

Significance and clinical outcome of lymph node level assessment in biliary tract cancers.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 274-274
Author(s):  
Joaquina Martínez-Galán ◽  
Jesús Soberino ◽  
Cynthia S. González Rivas ◽  
Julia Ruiz Vozmediano ◽  
Lucia Portellano ◽  
...  
Keyword(s):  
Lymph Node ◽  
Surgical Resection ◽  
Median Survival ◽  
Biliary Tract ◽  
Celiac Trunk ◽  
Median Number ◽  
Curative Intent ◽  
Free Survival ◽  
Biliary Tract Cancers ◽  
The Impact

274 Background: Biliary tract cancers (BTCs) are relatively rare neoplasms encompass both cholangiocarcinoma (CC).The role of routine lymphadenectomy at the time of surgical resection remains poorly defined.We sought to identify factors associated with outcome following and examine the impact of lymph node (LN) assessment on survival. Methods: 43 pts who underwent curative intent surgery between 2000-10 were identified from a database.We calculated prognostic factors and impact lymph node assessment for survival. Results: A total 43 pts were identified with no metastatic BTCs.The median age was 65 years (29–82 years); PS0:33/43 (76%); PS1:8/43 (19%) and PS2:2/43 (5%) pts.A histological diagnosis of adenocarcinoma was confirmed in 100%.Surgical resection was performed in all patients.After resection 42% (18/43) had positive nodes.Adjuvant chemotherapy had 31/43(72%),preferred with gemcitabine and a median number of cycles 6. Grade 3 or 4 toxicities rarely occurred.During median follow-up of 6.6 years tumor recurrence or metastatic disease occurred in 63% with median survival global were 2 years and 1.5 years for disease free survival.For stage T, the median survival global rates were 58 months (95% CI 44.6-71.3) for T1-T2 and 35 months (95% CI 23.3-46.8) for T3-T4 p=0.015 and for median recidive-free survival were 23 months (95% CI 11.8-34) for T1-T2 and 14 months (95% CI 6.5-21) for T3-T4 p=0.05.For N stage, the median SG were 58 months (95% CI 50.5-65.4) for negative nodes and 26 months (95% CI 3.7-48.2) for positive nodes p=0.003 and for median recidive-free survival were 55 months (95% CI 31.7-57.5) for negative nodes and 10 months (95% CI 6.8-13) for positive nodes p=0.006.The pts who had nodal affectation in hepatic hilio had better recidive-free survival that those patients who had nodal affectation in celiac trunk p<0.05. Conclusions: This represents a biliary cancer cohort with survival benchmarks obtained in the modern era of multidisciplinary care.Surgical resection and adjuvant QT offers the optimal treatment outcome in patients with ICC.From our results depth of tumor invasion (T),the presence the lymph node metastases (N) and level nodal affections are the strongest predictors of relapse and survival.

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