Frakulli Rezarta, Buwenge Milly, Macchia Gabriella, Cammelli Silvia, Deodato Francesco, Cilla Savino, Cellini Francesco, Mattiucci Gian C, Bisello Silvia, Brandi Giovanni, Parisi Salvatore, Morganti Alessio G
1 Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy.
2 Radiotherapy Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart , Campobasso , Italy.
Br J Radiol. 2019 May;92(1097):20180688. doi: 10.1259/bjr.20180688. Epub 2019 Feb 7.
Stereotactic body radiation therapy (SBRT) has been used in the treatment of cholangiocarcinoma (CC) but toxicity and clinical results of SBRT in CC are still limited and sparse. Therefore, the aim of this systematic review was to analyze the results of SBRT in the setting of advanced CC.
A systematic literature search was conducted on PubMed, Scopus, and Cochrane library using the PRISMA methodology. Studies including at least 10 patients with diagnosis of advanced CC regardless of tumor site and other treatments were included. The primary outcome was overall survival (OS) and secondary endpoints were local control (LC) and toxicity rates. The ROBINS-I risk of bias tool was used.
10 studies (231 patients) fulfilled the selection criteria and were included in this review. All but one study showed moderate to serious risk of bias. Median follow up was 15 months (range: 7.8-64.0 months). Pooled 1 year OS was 58.3% ( CI: 50.2-66.1%) and pooled 2 year OS was 35.5% ( CI: 22.1-50.1%). Pooled 1 year LC was 83.4%, ( CI: 76.5-89.4%). The reported toxicities were acceptable and manageable with only one treatment-related death.
The role of SBRT in CC is not yet supported by robust evidence in literature. However, within this limit, preliminary results seem almost comparable to the ones of standard chemotherapy or chemoradiation.
SBRT seems effective in terms of LC with acceptable treatment-related toxicities. Therefore, SBRT can be considered a therapeutic option at least in selected patients with CC, possibly combined with adjuvant chemotherapy (CHT).
立体定向体部放射治疗（SBRT）已用于胆管癌（CC）的治疗，但SBRT治疗CC的毒性和临床结果仍然有限且资料稀少。因此，本系统评价的目的是分析SBRT在晚期CC治疗中的结果。
采用PRISMA方法在PubMed、Scopus和Cochrane图书馆进行系统的文献检索。纳入的研究包括至少10例诊断为晚期CC的患者，无论肿瘤部位和其他治疗方法如何。主要结局是总生存期（OS），次要终点是局部控制（LC）和毒性率。使用ROBINS-I偏倚风险工具。
10项研究（231例患者）符合选择标准并纳入本评价。除一项研究外，所有研究均显示出中度至严重的偏倚风险。中位随访时间为15个月（范围：7.8 - 64.0个月）。汇总的1年总生存率为58.3%（可信区间：50.2 - 66.1%），汇总的2年总生存率为35.5%（可信区间：22.1 - 50.1%）。汇总的1年局部控制率为83.4%（可信区间：76.5 - 89.4%）。报告的毒性是可接受且可控制的，仅有1例与治疗相关的死亡。
文献中尚无有力证据支持SBRT在CC治疗中的作用。然而，在此范围内，初步结果似乎与标准化疗或放化疗的结果相近。
SBRT在局部控制方面似乎有效，且治疗相关毒性可接受。因此，至少在部分CC患者中，SBRT可被视为一种治疗选择，可能与辅助化疗（CHT）联合使用。
