Stereotactic Body Radiotherapy (SBRT) for Intrahepatic and Hilar Cholangiocarcinoma

Abstract

Background: Unresectable intrahepatic and hilar cholangiocarcinomas carry a dismal prognosis. Systemic chemotherapy and conventional external beam radiation and brachytherapy have been used with limited success. We explored the use of stereotactic body radiotherapy (SBRT) for these patients.Methods: Patients with unresectable intrahepatic or hilar cholangiocarcinoma or those with positive margins were included in this study. Systemic therapy was used at the discretion of the medical oncologist. The CyberknifeTM stereotactic body radiotherapy system used to treat these patients. Patients were treated with three daily fractions. Clinical and radiological follow-up were performed every three months.Results: 34 patients (16 male and 18 female) with 42 lesions were included in this study. There were 32 unresectable tumors and two patients with resected tumors with positive margins. The median SBRT dose was 30Gy in three fractions. The median follow-up was 38 months (range 8-71 months). The actuarial local control rate was 79%. The median overall survival was 17 months and the median progression free survival was ten months. There were four Grade III toxicities (12%), including duodenal ulceration, cholangitis and liver abscess.Conclusions: SBRT is an effective and reasonably safe local therapy option for unresectable intrahepatic or hilar cholangiocarcinoma.

Radiation therapy for hepatobiliary malignancies

“…Mahadevan et al recently reported the results of 32 patients with primarily unresectable IHCC treated with CyberKnife SBRT to a total dose of 30 Gy in 3 fractions with approximately half of these patient receiving adjuvant gemcitabine with or without cisplatin (40). After a median follow-up of 38 months, 1-year local control and OS was 88% and 58%, respectively.…”

Locoregional therapies in cholangiocarcinoma

“…Grade I/II complications occurred in 29% and grade III/IV complications in 10% with one mortality from gastric perforation. Mahadevan et al used SBRT in 32 patients with unresectable or recurrent intrahepatic or perihilar cholangiocarcinoma and found SBRT to be associated with a median OS of 17 months [82]. Sandler et al recently reported on the use of SBRT as a neoadjuvant therapy prior to OLT for unresectable intrahepatic or perihilar cholangiocarcinoma (n = 31) [83].…”

Is there any Role of Radiotherapy in Intrahepatic Cholangiocarcinomas?

“…Mahadevan et al [15] treated unresectable IHCC with SBRT and have given radiotherapy dose of 30Gy in 3 fractions with some patients receiving chemotherapy also. After a median follow-up of 38 months, 1-year local control and OS was 88% and 58%, respectively [15].…”

“…After a median follow-up of 38 months, 1-year local control and OS was 88% and 58%, respectively [15]. Jung et al [16] treated unresectable and recurrent cases of IHCC and EHCC with total doses of SBRT being given as 45Gy in 3 fractions [16].…”