Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma

Jung, Da Hoon; Kim, Misook; Cho, Chul Koo; Yoo, Hyun Jung; Jang, Won Il; Seo, Young Seok; Paik, Eun Kyung; Kim, Kum Bae; Han, Chul Ju; Kim, Sang Bum

doi:10.3857/roj.2014.32.3.163

Cited by 65 publications

(88 citation statements)

References 17 publications

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“…Similar to the patients in our study, treatment margins of approximately 5 mm were used. The third study was a larger series that was published in 2014 and included 58 patients (half with primary tumors and half with recurrent disease) who were treated with SBRT 19 . The rates of local control at 1- and 2-year follow-up were 85% and 72%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for locally advanced extrahepatic and intrahepatic cholangiocarcinoma

Sandler

Veruttipong

Agopian

et al. 2016

Advances in Radiation Oncology

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ObjectivesWe report single-institution clinical efficacy and safety outcomes for patients with unresectable locally advanced cholangiocarcinoma who were treated with stereotactic body radiation therapy (SBRT) and a subset of patients who received neoadjuvant SBRT and chemotherapy as part of an orthotopic liver transplantation (OLT) protocol.Methods and materialsFrom October 2008 to June 2015, 31 consecutive patients with unresectable extrahepatic (n = 25) or intrahepatic (n = 6) cholangiocarcinoma were treated with SBRT and retrospectively analyzed. Four patients underwent liver transplantation, and 1 underwent resection. SBRT was delivered in 5 fractions with a median dose of 40 Gy. Toxicity was scored using the Common Terminology Criteria for Adverse Events Version 4.0. Overall survival (OS), time to progression, and local control were estimated using the Kaplan-Meier method.ResultsThe median follow-up time was 11.5 months. The 1- and 2-year OS rates were 59% and 33%, respectively, with a median survival of 15.7 months. The 1- and 2-year freedom from progression was 67% and 34%, respectively. Median time to progression was 16.8 months. Nine patients had local failure. The actuarial 1- and 2-year local control rates were 78% and 47%, respectively. Among patients who also had OLT, the median OS was 31.3 months. Twenty-four patients (77%) experienced some form of acute grade 1-2 toxicity, most commonly fatigue or pain. Five patients (16%) experienced grade ≥3 toxicity.ConclusionsSBRT is a promising option for patients with unresectable or recurrent cholangiocarcinoma either as a component of neoadjuvant therapy prior to OLT or as part of definitive therapy for patients who are unresectable and not eligible for transplantation.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for locally advanced extrahepatic and intrahepatic cholangiocarcinoma

Sandler

Veruttipong

Agopian

et al. 2016

Advances in Radiation Oncology

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“…Evidence for its use in cholangiocarcinoma is restricted to retrospective single institution studies. Jung et al reported outcomes in patients with unresectable primary or recurrent postoperative intrahepatic cholangiocarcinoma treated with SBRT (n = 53) or conventional EBRT plus SBRT boost (n = 5) and found a median OS of 10 months [81]. Grade I/II complications occurred in 29% and grade III/IV complications in 10% with one mortality from gastric perforation.…”

Section: Radiation Oncological Therapiesmentioning

confidence: 99%

Locoregional therapies in cholangiocarcinoma

et al. 2017

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Cholangiocarcinoma is a rare and aggressive malignancy of the biliary tract. Complete surgical resection can be curative, but the majority of patients are diagnosed with advanced disease and usually die within a year of diagnosis. Most deaths are attributable to local disease progression rather than distant metastases, supporting the use of locoregional therapies. There is evidence that locoregional therapies can provide local tumor control resulting in increased survival while avoiding some of the side effects of systemic treatments, increasing potential treatment options for patients who may be unsuitable for systemic palliative treatments. This review considers the evidence for locoregional therapies in cholangiocarcinoma, which can be classified into endoscopic, vascular, percutaneous and radiation oncological therapies. Current guidelines do not recommend the routine use of locoregional therapies due to a lack of prospective data, but the results of ongoing trials are likely to increase the evidence base and impact on clinical practice.

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“…Small studies have shown good local disease control and potential survival benefit of SBRT alone or combined with EBRT for unresectable and recurrent CC. 136,137 To minimize the radiation-induced toxicity, treatment with proton beams has been suggested. A recent study demonstrated that after percutaneous implantation of fiducial markers for localization, proton beam therapy was associated with an increased median survival compared to palliative care (27.5 vs 10 months), making it a potentially promising modality in the management of locally advanced ICC.…”

Section: Radiotherapy For Unresectable Cholangiocarcinomamentioning

confidence: 99%

Comprehensive management of cholangiocarcinoma: Part II. Treatment

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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Cholangioarcinoma is a rare but dreadful malignancy which poses much difficulties in the management. If detected early with only localized disease, curative resection is possible. However, most patients present in the late stages of the disease, which are managed with endoscopic biliary drainage and/or chemoradiation. Liver transplantation offers a possibility for cure in the distal and the perihilar tumors for selected candidates. Local treatments, such as hepatic artery-based therapies, brachytherapy, and photodynamic therapy, may offer some benefit in cases of the advanced disease. In this review, we will assess the role of preoperative biliary drainage, how best to drain biliary obstruction, and the intricate details of various treatments that are currently available. Management of Cholangiocarcinoma Preoperative biliary drainagePreoperative biliary drainage (PBD) is achieved with endoscopic or percutaneous approach. The topic is controversial and the review of the literature revealed conflicting results. PBD of the future remnant hepatic lobe is supposed to decrease hepatic dysfunction and liver failure postoperatively.1 The meta-analysis found no difference in mortality between patients with and without PBD and the authors advised that such procedure should not be performed routinely.2 Another meta-analysis of almost 5,000 patients with distal obstruction (425 with distal cholangiocarcinoma [DCC]) did not find any evidence that PBD (without distinguishing between endoscopic or percutaneous approach) increases morbidity or mortality. However it was associated with significant bacterial infection of the bile and possibly adverse outcomes after surgery.3 Other studies showed that PBD reduced jaundice, which positively affected outcomes, but not survival, and that it might be associated with more intraoperative blood loss, but less reoperation rates compared to non-drained cases. 4,5 The prospective randomized study of almost 200 patients with cancer of the head of the pancreas demonstrated that PBD was associated with more non-surgical adverse events compared to those managed only with surgery (46% vs 2%, respectively). Surgical adverse events were also more in the PBD group (47% vs 37%). The high incidence of cholangitis in those treated with PBD may be associated with the long lag time between PBD and surgery (5 weeks) and the high occlusion rate of plastic stents (PSs) (15%), prompting other authors to suggest that use of short, self-expandable metal stents (SEMS) may result in better outcomes for distal bile duct strictures. In accordance with other studies, there was no effect of PBD on mortality.6,7 In perihilar cholangiocarcinoma (PCC), the systematic review of 700 patients with and without PBD suggested that there is higher incidence of postoperative infections (18%-52% vs 0%-27%) and overall adverse events (36%-100% vs 29%-72%) in the PBD compared to the non-PBD group. There was no difference in mortality in the two groups. 8 Other studies favor the use of PBD in the preoperative management of PCC. ...

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Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma

Cited by 65 publications

References 17 publications

Stereotactic body radiotherapy (SBRT) for locally advanced extrahepatic and intrahepatic cholangiocarcinoma

Stereotactic body radiotherapy (SBRT) for locally advanced extrahepatic and intrahepatic cholangiocarcinoma

Locoregional therapies in cholangiocarcinoma

Comprehensive management of cholangiocarcinoma: Part II. Treatment

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