Carcinoma of the extrahepatic biliary system—results of primary and adjuvant radiotherapy

Fields, Joseph N.; Emami, Bahman

doi:10.1016/0360-3016(87)90006-x

Cited by 86 publications

(28 citation statements)

References 23 publications

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“…The optimal radiation dose in the definitive treatment of biliary malignancies remains unknown, but some authors recommend dose level over 45 to 50 Gy in 5 weeks [25,26] . Since larger volumes will not tolerate a higher dose administrated with external beam irradiation, internal irradiation with iridium-192 seems to be an attractive approach to boost the area where more tumor burden exists [27-30]. More recently, stereotactic fractionated radiotherapy was shown promising to increase the rate of local control [31].…”

Section: Discussionmentioning

confidence: 99%

Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma

et al. 2013

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BackgroundOptimal therapy for patients with unresectable locally advanced extrahepatic cholangiocarcinoma (ULAC) remains controversial. We analysed the role of radiotherapy in the management of such tumors.MethodsWe retrospectively reviewed the charts of patients treated in our institution with conformal-3D external-beam-radiotherapy (EBRT) with or without concurrent chemotherapy.ResultsThirty patients were included: 24 with a primary tumor (group 1) and 6 with a local relapse (group 2). Toxicity was low. Among 25 patients assessable for EBRT response, we observed 9 complete responses, 4 partial responses, 10 stabilisations, and 2 progressions. The median follow-up was 12 months. Twenty out of 30 patients (66%) experienced a relapse, which was metastatic in 75% of cases in the whole series, 87% in group 1, 60% in group 2 (p = 0.25). Twenty-eight patients (93%) died of relapse or disease complications. Median overall survivals in the whole group and in group 1 or 2 were respectively 12, 11 and 21 months (p = 0.11). The 1-year and 3-year progression-free survivals were respectively 38% and 16% in the whole series; 31% and 11% in group 1, 67% and 33% in group 2 (p = 0.35).ConclusionEBRT seems efficient to treat ULAC, with acceptable toxicity. For primary disease, the high rate of metastatic relapse suggests to limit EBRT to non-progressive patients after induction chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma

et al. 2013

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“…Patients receiving cumulative doses in excess of 45 Gy are more likely to have superior local control and, in some cases, overall survival compared to patients receiving less than 45 Gy. 21,[23][24][25]28 Our current policy is to approach both proximal and distal tumors with maximal surgical resection followed by EBRT and brachytherapy to combined total dose of 55 to 60 Gy. Our outcomes have been supported by others in the literature with the use of surgical resection and high-dose brachytherapy irrespective of tumor location.…”

Section: Discussionmentioning

confidence: 99%

Cholangiocarcinoma: The Impact of Tumor Location and Treatment Strategy on Outcome

Heron

Stein

Eschelman

et al. 2003

American Journal of Clinical Oncology

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The purpose of this study was to evaluate how the outcome of patients with extrahepatic cholangiocarcinoma (EHBC) may have been influenced by tumor location and treatment selection. The primary endpoint of this study is overall survival (OS). Between January 1983 and December 1997, 221 patients with biliary tumors were evaluated at Thomas Jefferson University Hospital. Of these, 118 fit the inclusion criteria for this study. The extent of disease was assessed by computed tomography, percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, and ultrasonography. All patients had histologic confirmation of malignancy. Roux-en Y, hepaticojejunostomy, or choledochojejunostomy followed surgical resection of the primary tumor. Palliative measure (PS) included biliary catheter placement without brachytherapy or external beam irradiation (RT). RT was delivered via high-energy photons. Intraluminal brachytherapy was performed via percutaneous biliary catheterization with iridium-192 ribbon sources. Chemotherapy consisted of either intravenous 5-fluorouracil alone or in combination with doxorubicin, mitomycin C, or paclitaxel. PS consisted of metal bile duct stent placement. Median follow-up time for the entire group was 102 months and 43 months for patients who were still alive at the conclusion of the study period. Patients with proximal tumors underwent resection (n = 5), surgery and RT (n = 23), RT only (n = 31), chemotherapy only (n = 6), or PS (n = 12). Patients with distal tumors were treated with surgical resection (n = 17) or a combination of surgery and RT (n = 13), RT only (n = 6), or PS (n = 4). Median survival time (MST) for all 118 patients was 22 months. The MST for patients with distal tumors was 47 months versus 17 months for those with proximal tumors. The MST has not been reached for patients with distal EHBC treated with surgical resection and postoperative RT, whereas the median survival for those treated with surgery alone is 62.5 months. However, 4 of 17 of these patients had in situ carcinoma. Six patients had distal tumors treated with RT only with a MST of 6 months. Patients with proximal tumors treated with surgery and RT had a superior OS at 5 years compared to patients treated with RT alone (24 vs. 13 months; p = 0.007). There was an improved OS in patients with proximal tumors treated with surgical resection and RT compared to surgery alone (p = 0.023). There is no discernable influence of chemotherapy on outcome in patients with proximal EHBC. The MST for patients treated with PS was 3.5 months. Surgery and postoperative RT appear to be better than either surgery or RT alone in patients with proximal EHBC. In patients with distal EHBC, the addition of resection and RT appears to offer an advantage, which is increasingly apparent with longer follow-up time. The prognosis remains dismal for patients treated with palliative intent.

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“…We also did not include brachytherapy in our analysis. Previous retrospective investigations have indicated that the addition of brachytherapy to external beam radiation does not improve survival [18], although others have suggested improvement in survival [26].…”

Section: Discussionmentioning

confidence: 99%

The Role of Postoperative Radiation Therapy (PORT) in the Treatment of Extrahepatic Bile Duct Cancer: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Investigation

Decker

Knisely

2008

J Gastrointest Canc

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Based on analysis of the SEER database, there was no definitive evidence for improved survival with the addition of PORT to radical surgery. This analysis should be approached with caution given its observational and retrospective nature. In addition, it should be remembered that the SEER database lacks information on the use of chemotherapy, radiation technique, and the completeness of resection.

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Carcinoma of the extrahepatic biliary system—results of primary and adjuvant radiotherapy

Cited by 86 publications

References 23 publications

Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma

Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma

Cholangiocarcinoma: The Impact of Tumor Location and Treatment Strategy on Outcome

The Role of Postoperative Radiation Therapy (PORT) in the Treatment of Extrahepatic Bile Duct Cancer: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Investigation

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