Hurmuz Pervin, Kahvecioglu Alper, Ozyigit Gokhan, Dizdar Omer, Cengiz Mustafa
Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Radiat Oncol J. 2025 Jun;43(2):57-62. doi: 10.3857/roj.2024.00437. Epub 2025 Jun 25.
For patients with unresectable extrahepatic cholangiocarcinoma, radiotherapy (RT) is the definitive treatment. In this study, we aimed to evaluate the role of two different RT techniques for definitive treatment of unresectable extrahepatic cholangiocarcinoma.
Eighteen patients with unresectable extrahepatic cholangiocarcinoma treated with either conventionally fractionated radiotherapy (CFRT) or stereotactic body radiotherapy (SBRT) were evaluated retrospectively. Patients treated with CFRT also received elective nodal irradiation (ENI) in addition to the primary tumor.
Median doses of CFRT and SBRT were 50.4 Gy (range, 45 to 59.4) in 25-33 fractions and 37.5 Gy (range, 27.5 to 50) in 3-5 fractions, respectively. Median follow-up was 22 months (range, 7 to 138). During follow-up, local failure occured in one patient (12.5%) in the SBRT group and six patients (60.0%) in the CFRT group (p = 0.041). On the other hand, regional failure occured in five patients (62.5%) in the SBRT group and in two patients (20.0%) in the CFRT group (p = 0.047). Two-year overall survival (OS), local-regional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) rates were 35%, 30%, and 24%, respectively. Younger age (≤55 years) was associated with better OS, LRFFS, and DMFS. None of the patients experienced ≥grade 3 acute or late toxicity.
While SBRT may provide better local tumor control compared to CFRT, the absence of ENI can result in increased regional recurrences. Hence, conducting prospective studies to examine the safety and efficacy of integrating hypofractionated ENI into SBRT is warranted.
对于无法切除的肝外胆管癌患者，放射治疗（RT）是确定性治疗方法。在本研究中，我们旨在评估两种不同的放射治疗技术在无法切除的肝外胆管癌确定性治疗中的作用。
回顾性评估18例接受常规分割放射治疗（CFRT）或立体定向体部放射治疗（SBRT）的无法切除的肝外胆管癌患者。接受CFRT治疗的患者除了原发肿瘤外还接受了选择性淋巴结照射（ENI）。
CFRT和SBRT的中位剂量分别为25 - 33分次的50.4 Gy（范围45至59.4）和3 - 5分次的37.5 Gy（范围27.5至50）。中位随访时间为22个月（范围7至138）。随访期间，SBRT组有1例患者（12.5%）发生局部失败，CFRT组有6例患者（60.0%）发生局部失败（p = 0.041）。另一方面，SBRT组有5例患者（62.5%）发生区域失败，CFRT组有2例患者（20.0%）发生区域失败（p = 0.047）。两年总生存率（OS）、局部区域无失败生存率（LRFFS）和远处转移无失败生存率（DMFS）分别为35%、30%和24%。年龄较轻（≤55岁）与较好的OS、LRFFS和DMFS相关。没有患者出现≥3级急性或晚期毒性反应。
虽然与CFRT相比，SBRT可能提供更好的局部肿瘤控制，但缺乏ENI可导致区域复发增加。因此，有必要进行前瞻性研究以检验将低分割ENI纳入SBRT的安全性和有效性。
