Editing Cholangiocarcinoma (section)

===Adjuvant chemotherapy and radiation therapy===
If the tumor can be removed surgically, people may receive [[adjuvant therapy|adjuvant]] [[chemotherapy]] or [[radiation therapy]] after the operation to improve the chances of cure. If the tissue margins are negative (i.e. the tumor has been totally [[:wikt:excision|excised]]), adjuvant therapy is of uncertain benefit. Both positive<ref>{{cite journal | vauthors = Todoroki T, Ohara K, Kawamoto T, Koike N, Yoshida S, Kashiwagi H, Otsuka M, Fukao K | display-authors = 6 | title = Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma | journal = International Journal of Radiation Oncology, Biology, Physics | volume = 46 | issue = 3 | pages = 581–7 | date = February 2000 | pmid = 10701737 | doi = 10.1016/S0360-3016(99)00472-1 }}</ref><ref>{{cite journal | vauthors = Alden ME, Mohiuddin M | title = The impact of radiation dose in combined external beam and intraluminal Ir-192 brachytherapy for bile duct cancer | journal = International Journal of Radiation Oncology, Biology, Physics | volume = 28 | issue = 4 | pages = 945–51 | date = March 1994 | pmid = 8138448 | doi = 10.1016/0360-3016(94)90115-5 }}</ref> and negative<ref name="nakeeb"/><ref>{{cite journal | vauthors = González González D, Gouma DJ, Rauws EA, van Gulik TM, Bosma A, Koedooder C | title = Role of radiotherapy, in particular intraluminal brachytherapy, in the treatment of proximal bile duct carcinoma | journal = Annals of Oncology | volume = 10 | issue = Suppl 4 | pages = 215–20 | year = 1999 | pmid = 10436826 | doi = 10.1023/A:1008339709327 }}</ref><ref>{{cite journal | vauthors = Pitt HA, Nakeeb A, Abrams RA, Coleman J, Piantadosi S, Yeo CJ, Lillemore KD, Cameron JL | display-authors = 6 | title = Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival | journal = Annals of Surgery | volume = 221 | issue = 6 | pages = 788–97; discussion 797–8 | date = June 1995 | pmid = 7794082 | pmc = 1234714 | doi = 10.1097/00000658-199506000-00017 }}</ref> results have been reported with adjuvant radiation therapy in this setting, and no prospective [[randomized controlled trial]]s have been conducted as of March 2007. Adjuvant chemotherapy appears to be ineffective in people with completely resected tumors.<ref>{{cite journal |last1=Luvira |first1=V |last2=Satitkarnmanee |first2=E |last3=Pugkhem |first3=A |last4=Kietpeerakool |first4=C |last5=Lumbiganon |first5=P |last6=Pattanittum |first6=P |title=Postoperative adjuvant chemotherapy for resectable cholangiocarcinoma. |journal=The Cochrane Database of Systematic Reviews |date=13 September 2021 |volume=2021 |issue=9 |pages=CD012814 |doi=10.1002/14651858.CD012814.pub2 |pmid=34515993|pmc=8437098 }}</ref><ref>{{cite journal | vauthors = Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T | display-authors = 6 | title = Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma | journal = Cancer | volume = 95 | issue = 8 | pages = 1685–95 | date = October 2002 | pmid = 12365016 | doi = 10.1002/cncr.10831 | doi-access = free }}</ref> The role of combined chemoradiotherapy in this setting is unclear. If the tumor tissue margins are positive, indicating the tumor was not completely removed via surgery, then adjuvant therapy with radiation and possibly chemotherapy is generally recommended based on the available data.<ref name="nccn">{{cite web|url= https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf |title=National Comprehensive Cancer Network (NCCN) guidelines on evaluation and treatment of hepatobiliary malignancies |access-date=13 March 2007|url-access=registration}}</ref>
<ref name="nccn2021">{{cite web |url=https://www.nccn.org/patients/guidelines/content/PDF/gallandbile-hp-patient.pdf  |title=NCCN Guidelines for Patients: Gallbladder and Bile Duct Cancers; Hepatobiliary Cancers |date=2021 |access-date=10 February 2021 |publisher=National Comprehensive Cancer Network }}</ref>