Kim Byoung Hyuck, Chie Eui Kyu, Kim Kyubo, Jang Jin-Young, Kim Sun Whe, Oh Do-Youn, Bang Yung-Jue, Ha Sung W
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, Republic of Korea.
Oncotarget. 2017 Apr 21;8(44):78076-78085. doi: 10.18632/oncotarget.17368. eCollection 2017 Sep 29.
This study was conducted to evaluate the impact of radiation dose after margin involved resection in patients with extrahepatic bile duct cancer.
Among the 251 patients who underwent curative resection followed by adjuvant chemoradiotherapy, 86 patients had either invasive carcinoma ( = 63) or carcinoma in situ ( = 23) at the resected margin. Among them, 54 patients received conventional radiation dose (40-50.4 Gy) and 32 patients received escalated radiation dose (54-56 Gy).
Escalated radiation dose was associated with improved locoregional control (5yr rate, 73.8% . 47.1%, = 0.069), but not disease-free survival (5yr rate, 43.4% . 32.6%, = 0.490) and overall survival (5yr rate, 40.6% . 29.6%, = 0.348). In multivariate analysis for locoregional control, invasive carcinoma at the margin (HR 2.957, = 0.032) and escalated radiation dose (HR 0.394, = 0.047) were independent prognostic factors. No additional gastrointestinal toxicity was observed in escalated dose group.
Delivery of radiation dose ≥ 54 Gy was well tolerated and associated with improved locoregional control, but not with overall survival after margin involved resection. Further validation study is warranted.
本研究旨在评估肝外胆管癌患者切缘受累切除术后放疗剂量的影响。
在251例行根治性切除并接受辅助放化疗的患者中，86例患者在切除边缘存在浸润性癌（n = 63）或原位癌（n = 23）。其中，54例患者接受常规放疗剂量（40 - 50.4 Gy），32例患者接受递增放疗剂量（54 - 56 Gy）。
递增放疗剂量与局部区域控制改善相关（5年率，73.8% 对 47.1%，P = 0.069），但与无病生存率（5年率，43.4% 对 32.6%，P = 0.490）和总生存率（5年率，40.6% 对 29.6%，P = 0.348）无关。在局部区域控制的多因素分析中，边缘浸润性癌（HR 2.957，P = 0.032）和递增放疗剂量（HR 0.394，P = 0.047）是独立的预后因素。递增剂量组未观察到额外的胃肠道毒性。
放疗剂量≥54 Gy耐受性良好，与局部区域控制改善相关，但与切缘受累切除术后的总生存率无关。有必要进行进一步的验证研究。
