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We evaluated the impact of radiotherapy on survival in elderly patients using the <jats:styled-content style=\"fixed-case\">SEER<\/jats:styled-content>\u2010Medicare database. Patients in the <jats:styled-content style=\"fixed-case\">SEER<\/jats:styled-content>\u2010Medicare database with inoperable biliary tract tumors diagnosed between 1998 and 2011 were included. We used multivariate logistic regression to evaluate factors associated with treatment selection, and multivariate Cox regression and propensity score matching to evaluate treatment selection in relation to subsequent survival. Of the 2343 patients included, 451 (19%) received radiotherapy within 4\u00a0months of diagnosis. The use of radiotherapy declined over time, and was influenced by receipt of chemotherapy and patient age, race, marital status, poverty status, and tumor stage and type. Median survival was 9.3 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 8.7\u20139.7) months among patients who did not receive radiation and 10.0 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 9.1\u201311.3) months among those who received radiation, conditional on having survived 4\u00a0months. In patients who received chemotherapy (<jats:italic>n<\/jats:italic>\u00a0=\u00a01053), receipt of radiation was associated with improved survival, with an adjusted hazard ratio of 0.82 (95% 0.70\u20130.97, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02). In patients who did not receive chemotherapy (<jats:italic>n<\/jats:italic>\u00a0=\u00a01290), receipt of radiation was not associated with improved survival, with an adjusted hazard ratio of 1.09 (95% 0.91\u20131.30, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.34). Propensity\u2010scored matched analyses showed similar results. Despite the survival benefit associated with the addition of radiotherapy to chemotherapy, the use of radiation for unresectable biliary tract cancers has declined over time.<\/jats:p>","DOI":"10.1002\/cam4.975","type":"journal-article","created":{"date-parts":[[2016,11,28]],"date-time":"2016-11-28T08:58:40Z","timestamp":1480323520000},"page":"129-141","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Does radiotherapy still have a role in unresected biliary tract cancer?"],"prefix":"10.1002","volume":"6","author":[{"given":"Erqi L.","family":"Pollom","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muthuraman","family":"Alagappan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lesley S.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Health Research and Policy Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice S.","family":"Whittemore","sequence":"additional","affiliation":[{"name":"Department of Health Research and Policy Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert C.","family":"Koong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel T.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,11,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2007-0252"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.9-1-43"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199610000-00005"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl.2009.3.4.298"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0908721"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdi046"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdh096"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2004.10.026"},{"key":"e_1_2_8_10_1","unstructured":"National Comprehensive Cancer Network.Hepatobiliary Cancer (Version 2.2015). 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