Murakami Takashi, Aizawa Rihito, Matsuo Yukinori, Hanazawa Hideki, Taura Kojiro, Fukuda Akihisa, Uza Norimitsu, Shiokawa Masahiro, Kanai Masashi, Hatano Etsuro, Seno Hiroshi, Muto Manabu, Mizowaki Takashi
Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Radiation Oncology, Kurashiki Central Hospital, Okayama, Japan.
Cancer Diagn Progn. 2022 Nov 3;2(6):634-640. doi: 10.21873/cdp.10153. eCollection 2022 Nov-Dec.
BACKGROUND/AIM: Treatment options for unresectable cholangiocarcinoma are limited. The aim of the study was to evaluate the clinical outcomes of definitive external-beam radiation therapy (EBRT) for patients with unresectable cholangiocarcinoma.
Patients with unresectable primary cholangiocarcinoma, or local recurrent cholangiocarcinoma after primary surgery, without distant metastasis who received definitive EBRT (≥45 Gy) between January 2006 and December 2020 at our Institution were analyzed retrospectively. EBRT was basically performed using conventional fractionation (1.8-2 Gy per fraction). Prophylactic nodal irradiation was not performed.
A total of 21 consecutive patients were analyzed: 7 primary and 14 recurrent cases. The median age was 70 (range=38-85) years at initiation of EBRT. A median dose of 54 (range=45-60) Gy comprising 1.8 (range=1.8-3) Gy per fraction was administered to the primary/recurrent local tumor site. The median follow-up period was 21.6 months. The 2-year overall survival, cause-specific survival, progression-free survival, and local recurrence-free rates were 35.7, 35.7, 16.1, and 32.7%, respectively. Long-term local control (>2 years after EBRT) was achieved in 19.0%. Grade 3 toxicities related to EBRT were observed in 4.8% (duodenum hemorrhage). No grade 4 or higher toxicities were observed.
Definitive EBRT for unresectable cholangiocarcinoma was feasible and achieved long-term local control in a subset of patients. As the avoidance of local recurrence may lead to the benefits of prolonging biliary patency and subsequently alleviating the need for an invasive procedure for biliary drainage, EBRT could be one sustainable therapeutic option for patients with unresectable cholangiocarcinoma.
背景/目的：不可切除胆管癌的治疗选择有限。本研究的目的是评估不可切除胆管癌患者接受根治性外照射放疗（EBRT）的临床结局。
回顾性分析2006年1月至2020年12月在我院接受根治性EBRT（≥45 Gy）的不可切除原发性胆管癌或初次手术后局部复发性胆管癌且无远处转移的患者。EBRT基本采用常规分割（每次分割1.8 - 2 Gy）。未进行预防性淋巴结照射。
共分析了21例连续患者：7例原发性和14例复发性病例。EBRT开始时的中位年龄为70岁（范围 = 38 - 85岁）。对原发/复发局部肿瘤部位给予的中位剂量为54 Gy（范围 = 45 - 60 Gy），每次分割剂量为1.8 Gy（范围 = 1.8 - 3 Gy）。中位随访期为21.6个月。2年总生存率、病因特异性生存率、无进展生存率和局部无复发生存率分别为35.7%、35.7%、16.1%和32.7%。19.0%的患者实现了长期局部控制（EBRT后>2年）。观察到4.8%的患者出现与EBRT相关的3级毒性反应（十二指肠出血）。未观察到4级或更高等级的毒性反应。
不可切除胆管癌的根治性EBRT是可行的，并且在一部分患者中实现了长期局部控制。由于避免局部复发可能带来延长胆管通畅时间并随后减少胆管引流侵入性操作需求的益处，EBRT可能是不可切除胆管癌患者的一种可持续治疗选择。
