Outcomes of stereotactic body radiotherapy for unresectable cholangiocarcinoma: a meta-analysis and systematic review.

BACKGROUND

Stereotactic body radiotherapy (SBRT) is an effective treatment for various malignancies. This meta-analysis aimed to determine the prognostic outcomes and toxicities of SBRT for unresectable cholangiocarcinoma (CC) using the most recent evidence.

METHODS

The review protocol was registered on PROSPERO (CRD42023393642). We searched PubMed, EMBASE, and the Cochrane Library for studies involving SBRT and CC. Study endpoints included median overall survival (OS), 1- and 2-year OS rates, 1- and 2-year disease control rates (DCR), and the incidence of grade 3 or higher toxicities.

RESULTS

Thirteen studies (366 patients) were included. Of these, 138 patients (37.7%) had extrahepatic CC and 228 patients (62.3%) had intrahepatic CC. The median total SBRT dose was 45 Gy, and the median biologically effective dose (BED) was 72.0 Gy. The pooled median OS was 13.4 months (95% confidence interval (CI) [10.9-15.8]). Pooled 1-year and 2-year OS rates were 58.7% (95% CI [53.8-63.7%]) and 33.2% (95% CI [28.3-38.2%]), respectively. Pooled 1-year and 2-year DCR rates were 84.7% (95% CI [81.0-88.3%]) and 70.5% (95% CI [65.2-75.8%]), respectively. Pooled incidence rates for grade ≥3 acute, late, and overall toxicity were 6.4% (95% CI [2.6-10.1%]), 16.4% (95% CI [1.9-31.0%]), and 16.9% (95% CI [9.3-24.6%]), respectively. No factor was significantly associated with improved OS or DCR.

CONCLUSIONS

This meta-analysis demonstrates that SBRT may be an efficacious and safe therapeutic option for unresectable CC. Further prospective studies comparing SBRT with alternative treatment approaches are required to define its definitive role in managing CC.