Intention to study.

Prepping for oral boards and getting bogged down in the biliary tract data? Probably because, when data is weak, it makes management confusing. These ASCO Clinical Practice Guidelines for resected biliary cancer have a nice way of taking all the treatment options offered up by the NCCN and boiling them down to a straightforward approach. As we’ve previously discussed, adjuvant chemo for resected biliary cancer hinges on the “trend” toward improved survival in the BILCAP trial. Apparently (final pub forthcoming) the benefit becomes significant among an adjusted intention-to-treat population, so it’s recommended that patients with any resected biliary tract cancer be offered 6 months of adjuvant capecitabine. Radiation is added for those with extrahepatic or gallbladder cancer with positive resection margins. What about intrahepatic locations? If you’ve ever tried to contour a postop target volume there, you know the answer. An even bigger deterrent the high competing risk of distant failure. Here SBRT is reserved as an option only for the rare local-only failures. TBL: The optimal (ASCO) approach for resected biliary tract cancer is 6 months of adjuvant capecitabine with the addition of radiation for extrahepatic tumors with positive resection margins. | Shroff, J Clin Oncol 2019