同期放化疗与单纯化疗治疗不可切除的晚期肝内胆管细胞癌的疗效比较。
Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for advanced-stage unresectable intrahepatic cholangiocarcinoma.
机构信息
Center for Liver Cancer, National Cancer Center, 323 Ilsan-ro, Ilsan dong-gu, Goyang, Gyeonggi 411-769, South Korea.
出版信息
Radiat Oncol. 2013 Dec 21;8:292. doi: 10.1186/1748-717X-8-292.
BACKGROUND
A standard treatment for unresectable advanced-stage intrahepatic cholangiocarcinoma (IHCC) has not yet been established. Although neoadjuvant concurrent chemoradiotherapy (CCRT) and liver transplantation are associated with long-term survival in select patients, the outcomes of CCRT for advanced-stage unresectable IHCC remain unclear. The aim of our study was to evaluate the outcomes of CCRT in patients with unresectable advanced-stage IHCC.
METHODS
We retrospectively reviewed the records of all patients with unresectable advanced stage (stage IVa or IVb) IHCC who were pathologically diagnosed and treated at National Cancer Center, Korea, from June 2001 to March 2012. Of the total of 92 patients, 25 (27.1%) received capecitabine plus cisplatin (XP) chemotherapy with external radiotherapy (RT) (XP-CCRT group) and 67 (72.8%) received XP chemotherapy alone (XP group). The clinical characteristics and outcomes of the 2 groups were compared.
RESULTS
The 92 patients comprised 72 male and 20 female patients, with a median age of 58 years (range 26-78 years). The baseline clinical characteristics of the 2 groups were similar. Patients in the XP-CCRT group received a mean 44.7 Gy of RT and a mean 5.6 cycles of XP chemotherapy, whereas patients in the XP group received a mean 4.0 cycles. The disease control rate was higher in the XP-CCRT group than in the XP group, but the difference was not statistically significant (56.0% vs. 41.5%, p = 0.217). Although neutropenia was significantly more frequent in the XP-CCRT than in the XP group (48% vs. 9%, p < 0.001), the rates of other toxicities and > grade 3 toxicities did not differ. At a median follow-up of 5.3 months, PFS (4.3 vs. 1.9 months, p = 0.001) and OS (9.3 vs. 6.2 months, p = 0.048) were significantly longer in the XP-CCRT than in the XP group.
CONCLUSIONS
XP-CCRT was well tolerated and was associated with longer PFS and OS than XP chemotherapy alone in patients with unresectable advanced IHCC. Controlled randomized trials are required to determine whether XP-CCRT is a primary treatment option for patients with unresectable advanced IHCC.
背景
目前尚未确定不可切除的晚期肝内胆管癌（IHCC）的标准治疗方法。虽然新辅助同步放化疗（CCRT）和肝移植与某些患者的长期生存相关，但 CCRT 治疗不可切除的晚期 IHCC 的结果仍不清楚。我们的研究目的是评估不可切除的晚期 IHCC 患者接受 CCRT 的结果。
方法
我们回顾性分析了 2001 年 6 月至 2012 年 3 月在韩国国家癌症中心经病理诊断和治疗的所有不可切除的晚期（IVa 或 IVb 期）IHCC 患者的记录。在总共 92 例患者中，25 例（27.1%）接受卡培他滨联合顺铂（XP）化疗联合外放疗（RT）（XP-CCRT 组），67 例（72.8%）仅接受 XP 化疗（XP 组）。比较了两组的临床特征和结果。
结果
92 例患者中，男 72 例，女 20 例，中位年龄 58 岁（26-78 岁）。两组患者的基线临床特征相似。XP-CCRT 组接受平均 44.7Gy RT 和平均 5.6 个周期的 XP 化疗，而 XP 组接受平均 4.0 个周期。与 XP 组相比，XP-CCRT 组的疾病控制率更高，但差异无统计学意义（56.0% vs. 41.5%，p=0.217）。虽然 XP-CCRT 组的中性粒细胞减少症发生率明显高于 XP 组（48% vs. 9%，p<0.001），但其他毒性和≥3 级毒性的发生率并无差异。中位随访 5.3 个月时，XP-CCRT 组的 PFS（4.3 个月 vs. 1.9 个月，p=0.001）和 OS（9.3 个月 vs. 6.2 个月，p=0.048）均显著长于 XP 组。
结论
XP-CCRT 耐受性良好，与不可切除的晚期 IHCC 患者单独接受 XP 化疗相比，可延长 PFS 和 OS。需要进行对照随机试验来确定 XP-CCRT 是否是不可切除的晚期 IHCC 患者的主要治疗选择。
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