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González, Daniel González; Gouma, D.J.; Rauws, E.A.J.; Gulik, T.M. van; Bosma, A.; Koedooder, C.

doi:10.1023/a:1008339709327

Cited by 26 publications

(9 citation statements)

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“…Potential advantages of intraluminal BT include administration of high radiation doses with rapid dose fall-off over a short distance from the radioactive source, thus sparing adjacent normal tissues and localizing dose to the tumor and peritumoral tissues, although dose to extramural disease may also be limited. Some investigators have reported a correlation of improvement in survival with the use of BT (11), while others have shown no obvious benefit (15) (Table 4). Occasionally, reports have described long-term survival in unresectable patients with the use of EBRT and transcatheter BT boost.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy in the Treatment of Patients With Unresectable Extrahepatic Cholangiocarcinoma

Ghafoori

Nelson

Willett

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Purpose Extrahepatic cholangiocarcinoma is an uncommon but lethal malignancy. We analyzed the role of definitive chemoradiotherapy for patients with nonmetastatic, locally advanced extrahepatic cholangiocarcinoma treated at a single institution. Methods and Materials This retrospective analysis included 37 patients who underwent external beam radiation therapy (EBRT) with concurrent chemotherapy and/or brachytherapy (BT) for locally advanced extrahepatic cholangiocarcinoma. Local control (LC) and overall survival (OS) were assessed, and univariate regression analysis was used to evaluate the effects of patient- and treatment-related factors on clinical outcomes. Results Twenty-three patients received EBRT alone, 8 patients received EBRT plus BT, and 6 patients received BT alone (median follow-up of 14 months). Two patients were alive without evidence of recurrence at the time of analysis. Actuarial OS and LC rates at 1 year were 59% and 90%, respectively, and 22% and 71%, respectively, at 2 years. Two patients lived beyond 5 years without evidence of recurrence. On univariate analysis, EBRT with or without BT improved LC compared to BT alone (97% vs. 56% at 1 year; 75% vs. 56% at 2 years; p = 0.096). Patients who received EBRT alone vs. BT alone also had improved LC (96% vs. 56% at 1 year; 80% vs. 56% at 2 years; p = 0.113). Age, gender, tumor location (proximal vs. distal), histologic differentiation, EBRT dose (≤ or >50 Gy), EBRT planning method (two-dimensional vs. three-dimensional), and chemotherapy were not associated with patient outcomes. Conclusions Patients with locally advanced extrahepatic cholangiocarcinoma have poor survival. Long-term survival is rare. The majority of patients treated with EBRT had local control at the time of death, suggesting that symptoms due to the local tumor effect might be effectively controlled with radiation therapy, and EBRT is an important element of treatment. Novel treatment approaches are indicated in the therapy for this disease.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy in the Treatment of Patients With Unresectable Extrahepatic Cholangiocarcinoma

Ghafoori

Nelson

Willett

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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“…Until now, no consensus has been established. Gonzalez Gonzalez et al suggested a dose >70 Gy because of the concept that CCA is a radio-resistant tumor 22. However, if radiation treatment with much higher dose caused serious toxicity that aborted treatment before completion, the patients would not benefit from adjuvant RT.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, resection margin may have influenced survival outcomes. However, several studies reported that the effect of margin status on survival among patients with resected pCCA who received adjuvant chemoradiation therapy is minimal 22,25. The SEER database lacks its ability to capture margin status and chemotherapy regimens, but it seems to have little impact on this study.…”

Section: Discussionmentioning

confidence: 99%

Results of adjuvant radiation therapy for locoregional perihilar cholangiocarcinoma after curative intent resection

Leng

Liu

Wang

et al. 2017

OTT

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PurposeThis study sought to define the role of adjuvant radiation therapy (RT) for patients with curative intent resection of perihilar cholangiocarcinoma (pCCA).Patients and methodsBy using the Surveillance, Epidemiology and End Results (SEER) registry, 1,917 patients with non-metastatic pCCA who underwent surgical resection from 1988 to 2009 were included in this study. Propensity score methods were used to compare the survival outcomes of patients treated with and without adjuvant RT after controlling for selection bias.ResultsOf the 1,917 patients, 762 (39.7%) received adjuvant RT. In the unmatched population, median overall survival (OS) for patients receiving adjuvant RT compared with those undergoing surgery alone was 23 versus 22 months (P=0.651). Patients who received adjuvant RT were younger (65 vs 68 years, P<0.001), had more regional diseases (86.0% vs 76.7%, P<0.001), and had more positive lymph nodes (43.8% vs 32.2%, P<0.001). In the matched population, adjuvant RT did not show better OS (22 vs 23 months, P=0.978) or cancer-specific survival (CSS) (17 vs 18 months, P=0.554).ConclusionAdjuvant RT is not associated with improved survival of patients with resected pCCA. These data suggest that adjuvant RT should not be routinely used to treat patients with pCCA outside research trials. Ideally, prospective randomized trials should be performed to verify the conclusion of this study.

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“…McMasters et al [95] described a case series of nine patients with extrahepatic CC who were successfully down-staged with external beam radiotherapy: 100% had negative resection margins following surgery. However, in a longer term study by Gonzalez et al [96], which used combinations of pre- and post-operative external beam radiotherapy, no impact on one, three or five year survival was observed. More recently Gwak et al [97] observed a downward trend in five-year survival following adjuvant radiotherapy (21% vs. 11.6%).…”

Section: Treatment Of Locally Advanced and Metastatic CCmentioning

confidence: 98%

Update on the Management of Cholangiocarcinoma

Skipworth

Keane²,

Pereira³

2014

Dig Dis

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Cholangiocarcinoma (CC) is a rare cancer arising from the epithelium of the biliary tree, anywhere from the small peripheral hepatic ducts to the distal common bile duct. Classification systems for CC typically group tumours by anatomical location into intrahepatic, hilar or extrahepatic subtypes. Surgical resection or liver transplantation remains the only curative therapy for CC, but up to 80% of patients present with advanced, irresectable disease. Unresectable CC remains resistant to many chemotherapeutic agents, although gemcitabine, particularly in combination with other agents, has been shown to improve overall survival. Ongoing investigation of biological agents has also yielded some promising results. Several novel interventional and endoscopic techniques for the diagnosis and management of non-operable CC have been developed: initial results show improvements in symptoms and progression-free survival, but further randomised studies are required to establish their role in the management of CC.

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Cited by 26 publications

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Radiotherapy in the Treatment of Patients With Unresectable Extrahepatic Cholangiocarcinoma

Radiotherapy in the Treatment of Patients With Unresectable Extrahepatic Cholangiocarcinoma

Results of adjuvant radiation therapy for locoregional perihilar cholangiocarcinoma after curative intent resection

Update on the Management of Cholangiocarcinoma

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