So the question remains -which adjuvant therapy, if any, is beneficial after resection of extrahepatic cholangiocarcinoma? The only prospectively controlled data that we have concludes that adjuvant radiation alone and adjuvant chemotherapy alone do not improve survival.5,10 Most of the retrospective series have suggested a modest survival benefit to radiotherapy with or without chemotherapy but suffer from small numbers, lack of prospective indications for adjuvant therapy, heterogenous patient populations and non-standardized therapies. Well-designed multi-institutional, phase III trials
are necessary to clarify the role of adjuvant therapy. Stratification based on tumor location, extent of resection, lymph node status and margin status before randomized will be crucial to the success of such studies.
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