Liu Ming-Yueh, Lo Cheng-Hsiang, Lin Chun-Shu, Chao Hsing-Lung, Yang Jen-Fu, Lin Kuen-Tze, Fan Chao-Yueh, Su Yu-Fu, Huang Wen-Yen
Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei - Taiwan.
Tumori. 2017 May 12;103(3):236-241. doi: 10.5301/tj.5000588. Epub 2017 Jan 5.
The role of stereotactic ablative radiotherapy (SABR) in patients with unresectable or medically inoperable cholangiocarcinoma remains unclear. We examined the efficacy and safety of SABR in this group of patients.
From January 2008 to December 2014, 15 patients with 17 lesions were included in this study. The lesions included 14 intrahepatic, 1 hilar, and 2 distal bile duct tumors. Three patients were classified as medically inoperable because of old age or multiple comorbidities. Tumors measured 0.8-13 cm (median, 3.6 cm). The median prescribed dose was 45 Gy delivered in 5 fractions over 5 consecutive days.
The median follow-up period for surviving patients was 29.9 months. Objective responses were observed for 10 of 17 tumors (58.8%), including 3 complete responses (17.6%). The median survival duration was 12.6 months, and the 1- and 2-year overall survival rates were 50.3% and 14.4%, respectively. The 1- and 2-year in-field failure-free rates were 61.5% and 30.8%, respectively. For patients with biologically effective doses (BEDs) exceeding 75 Gy10, the 1- and 2-year overall survival rates were 58.3% and 33.3%, respectively, compared to 20.0% and 0%, respectively for those with BEDs lower than 75 Gy10. Radiation-induced liver disease did not develop in any patient. Acute toxicities were generally mild and tolerable.
Stereotactic ablative radiotherapy could be an alternative treatment for unresectable or medically inoperable cholangiocarcinoma. Further dose escalation may be considered to optimize local control.
立体定向消融放疗（SABR）在不可切除或医学上无法手术的胆管癌患者中的作用仍不明确。我们研究了SABR在这类患者中的疗效和安全性。
2008年1月至2014年12月，本研究纳入了15例患者的17个病灶。病灶包括14个肝内、1个肝门和2个远端胆管肿瘤。3例患者因年龄较大或合并多种疾病而被归类为医学上无法手术。肿瘤大小为0.8 - 13厘米（中位数，3.6厘米）。规定的中位剂量为45 Gy，连续5天分5次给予。
存活患者的中位随访期为29.9个月。17个肿瘤中有10个（58.8%）观察到客观反应，包括3个完全缓解（17.6%）。中位生存时间为12.6个月，1年和2年总生存率分别为50.3%和14.4%。1年和2年野外无失败生存率分别为61.5%和30.8%。对于生物有效剂量（BED）超过75 Gy10的患者，1年和2年总生存率分别为58.3%和33.3%，而BED低于75 Gy10的患者分别为20.0%和0%。所有患者均未发生放射性肝病。急性毒性一般较轻且可耐受。
立体定向消融放疗可能是不可切除或医学上无法手术的胆管癌的一种替代治疗方法。可考虑进一步提高剂量以优化局部控制。
