Kim Eunji, Kim Yi-Jun, Kim Kyubo, Song Changhoon, Kim Jae-Sung, Oh Do-Youn, Nam Eun Mi, Chie Eui Kyu
1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
2 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2017 Dec;90(1080):20170308. doi: 10.1259/bjr.20170308. Epub 2017 Oct 9.
This study evaluated the outcome of salvage radiotherapy for locoregionally recurrent extrahepatic bile duct cancer.
We performed a retrospective review of 23 extrahepatic bile duct cancer patients who underwent radiotherapy with or without concomitant chemotherapy for isolated locoregional recurrence after radical surgery between August 2001 and September 2013. The median disease-free interval was 11.8 months. Salvage radiotherapy was delivered to the recurrent tumour with or without initial operation bed up to a median dose of 54 Gy (range, 45-60). 18 patients received concomitant chemotherapy.
The median follow-up period was 14.2 months for all patients, and 48.8 months for survivors. The median overall survival and progression-free survival (PFS) were 18.4 (range, 4.4-114.6) and 15.5 months (range, 1.6-114.6), respectively. On multivariate analysis, the use of concomitant chemotherapy was a favourable prognostic factor for PFS (p = 0.027), and prolonged disease-free interval (≥1 year) was associated with a significantly poor overall survival (p = 0.047). Grade 3 or higher toxicities did not occur in follow-up period.
Salvage radiotherapy showed promising survival outcomes in locoregional recurrence of extrahepatic bile duct cancer. Our results indicated that concomitant chemotherapy was associated with improved PFS. Concurrent chemoradiotherapy can be a viable salvage treatment option in selected patients. Advances in knowledge: Locoregional recurrence is the most common pattern of failure after radical resection in extrahepatic bile duct cancer. In this study, salvage radiotherapy showed favourable survival outcomes without severe complications in locoregionally recurrent extrahepatic bile duct cancer patients.
本研究评估了局部区域复发性肝外胆管癌挽救性放疗的疗效。
我们对2001年8月至2013年9月期间23例肝外胆管癌患者进行了回顾性研究，这些患者在根治性手术后出现孤立性局部区域复发，接受了放疗，部分患者同时接受了化疗。无病间期的中位数为11.8个月。对复发性肿瘤进行挽救性放疗，照射范围包括或不包括初始手术床，中位剂量为54 Gy（范围45 - 60 Gy）。18例患者接受了同步化疗。
所有患者的中位随访期为14.2个月，存活患者为48.8个月。中位总生存期和无进展生存期（PFS）分别为18.4个月（范围4.4 - 114.6个月）和15.5个月（范围1.6 - 114.6个月）。多因素分析显示，同步化疗是PFS的有利预后因素（p = 0.027），无病间期延长（≥1年）与总生存期显著较差相关（p = 0.047）。随访期间未发生3级或更高等级的毒性反应。
挽救性放疗在肝外胆管癌局部区域复发中显示出有前景的生存结果。我们的结果表明同步化疗与PFS改善相关。同步放化疗可能是部分患者可行的挽救性治疗选择。知识进展：局部区域复发是肝外胆管癌根治性切除后最常见的失败模式。在本研究中，挽救性放疗在局部区域复发性肝外胆管癌患者中显示出良好的生存结果且无严重并发症。
