Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2021 Jun 16;16(6):e0253285. doi: 10.1371/journal.pone.0253285. eCollection 2021.
More than half of patients with bile duct cancer (BDC) develop recurrence even after curative resection. Recurrent BDC has a poor prognosis, and no optimal treatment modality has been established. We therefore analyzed our experience on the survival outcomes of radiation therapy (RT) for recurrent extrahepatic bile duct cancer (EHBDC).
We retrospectively analyzed the records of patients with recurrent EHBDC who underwent concurrent chemoradiation therapy (CCRT) or RT alone at our institution between January 2001 and June 2015. Freedom from locoregional progression (FFLP), progression-free survival (PFS), and overall survival (OS) were assessed, and univariate and multivariate analyses were performed to identify the prognostic factors.
A total of 76 patients were included in the analysis. The median OS was 16 months and the rates of 2-year FFLP, PFS, and OS were 61%, 25%, and 33%, respectively. Among the evaluable patients, the first site of failure was the locoregional area in 16 patients, distant metastasis in 27, and both sites in 8. On univariate analysis, disease-free interval (p = 0.012) and concurrent chemotherapy (p = 0.040) were found as significant prognostic factors for OS. One patient with CCRT developed a grade 3 hematologic toxicity, and two patients experienced late grade 3 toxicities including duodenal ulcer bleeding and obstruction.
RT for recurrent EHBDC showed favorable survival and local control with limited treatment-related toxicities. Considering that the most common pattern of failure was distant metastasis, further studies on the optimal scheme of chemotherapy and RT are warranted.
即使在根治性切除后，仍有超过一半的胆管癌（BDC）患者会复发。复发性 BDC 预后较差，尚未确立最佳治疗方式。因此，我们分析了我们在复发性肝外胆管癌（EHBDC）放射治疗（RT）生存结果方面的经验。
我们回顾性分析了 2001 年 1 月至 2015 年 6 月期间在我院接受同期放化疗（CCRT）或单纯 RT 的复发性 EHBDC 患者的记录。评估无局部区域进展（FFLP）、无进展生存期（PFS）和总生存期（OS），并进行单因素和多因素分析以确定预后因素。
共纳入 76 例患者进行分析。中位 OS 为 16 个月，2 年 FFLP、PFS 和 OS 率分别为 61%、25%和 33%。在可评估患者中，16 例患者的首次失败部位为局部区域，27 例为远处转移，8 例为两者均有。单因素分析发现，无疾病间期（p=0.012）和同期化疗（p=0.040）是 OS 的显著预后因素。1 例 CCRT 患者发生 3 级血液学毒性，2 例患者发生晚期 3 级毒性，包括十二指肠溃疡出血和梗阻。
复发性 EHBDC 的 RT 治疗具有良好的生存和局部控制效果，且毒性反应有限。鉴于最常见的失败模式是远处转移，需要进一步研究化疗和 RT 的最佳方案。
