Sandler Kiri A, Veruttipong Darlene, Agopian Vatche G, Finn Richard S, Hong Johnny C, Kaldas Fady M, Sadeghi Saeed, Busuttil Ronald W, Lee Percy
Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Adv Radiat Oncol. 2016 Oct 29;1(4):237-243. doi: 10.1016/j.adro.2016.10.008. eCollection 2016 Oct-Dec.
We report single-institution clinical efficacy and safety outcomes for patients with unresectable locally advanced cholangiocarcinoma who were treated with stereotactic body radiation therapy (SBRT) and a subset of patients who received neoadjuvant SBRT and chemotherapy as part of an orthotopic liver transplantation (OLT) protocol.
From October 2008 to June 2015, 31 consecutive patients with unresectable extrahepatic (n = 25) or intrahepatic (n = 6) cholangiocarcinoma were treated with SBRT and retrospectively analyzed. Four patients underwent liver transplantation, and 1 underwent resection. SBRT was delivered in 5 fractions with a median dose of 40 Gy. Toxicity was scored using the Common Terminology Criteria for Adverse Events Version 4.0. Overall survival (OS), time to progression, and local control were estimated using the Kaplan-Meier method.
The median follow-up time was 11.5 months. The 1- and 2-year OS rates were 59% and 33%, respectively, with a median survival of 15.7 months. The 1- and 2-year freedom from progression was 67% and 34%, respectively. Median time to progression was 16.8 months. Nine patients had local failure. The actuarial 1- and 2-year local control rates were 78% and 47%, respectively. Among patients who also had OLT, the median OS was 31.3 months. Twenty-four patients (77%) experienced some form of acute grade 1-2 toxicity, most commonly fatigue or pain. Five patients (16%) experienced grade ≥3 toxicity.
SBRT is a promising option for patients with unresectable or recurrent cholangiocarcinoma either as a component of neoadjuvant therapy prior to OLT or as part of definitive therapy for patients who are unresectable and not eligible for transplantation.
我们报告了接受立体定向体部放射治疗（SBRT）的不可切除局部晚期胆管癌患者以及作为原位肝移植（OLT）方案一部分接受新辅助SBRT和化疗的部分患者的单机构临床疗效和安全性结果。
2008年10月至2015年6月，连续31例不可切除的肝外（n = 25）或肝内（n = 6）胆管癌患者接受了SBRT治疗并进行回顾性分析。4例患者接受了肝移植，1例患者接受了切除术。SBRT分5次进行，中位剂量为40 Gy。使用不良事件通用术语标准第4.0版对毒性进行评分。采用Kaplan-Meier方法估计总生存期（OS）、进展时间和局部控制率。
中位随访时间为11.5个月。1年和2年OS率分别为59%和33%，中位生存期为15.7个月。1年和2年无进展生存率分别为67%和34%。中位进展时间为16.8个月。9例患者出现局部失败。精算的1年和2年局部控制率分别为78%和47%。在也接受OLT的患者中，中位OS为31.3个月。24例患者（77%）经历了某种形式的1 - 2级急性毒性，最常见的是疲劳或疼痛。5例患者（16%）经历了≥3级毒性。
SBRT对于不可切除或复发性胆管癌患者是一种有前景的选择，可作为OLT前新辅助治疗的一部分，或作为不可切除且不符合移植条件患者的确定性治疗的一部分。
