High dose chemoradiation for unresectable hilar cholangiocarcinomas using intensity modulated external beam radiotherapy: a single tertiary care centre experience

Mehta, Shaesta; Kalyani, N.; Chaudhari, Suresh; Dharia, Tejas; Shetty, Nitin; Chopra, Supriya; Goel, Mahesh; Kulkarni, Suyash; Shrivastava, Shyam Kishore

doi:10.21037/jgo.2017.01.20

Cited by 12 publications

(11 citation statements)

References 18 publications

(23 reference statements)

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“…The role of conventional radiotherapy for unresectable HC is limited because its effectiveness in this setting has not been established [10,11]. Recent advances in medical radiation technology, including stereotactic body radiation therapy [12][13][14][15], intensity modulated radiotherapy [16,17], and intraluminal radiation therapy [18], can improve dose centralization in the target volume and may be used as alternative treatment options for unresectable HC. However, it is still difficult to perform radical radiation to the entire tumor using these modalities.…”

Section: Introductionmentioning

confidence: 99%

Space-Making Particle Therapy for Unresectable Hilar Cholangiocarcinoma

Komatsu

Terashima

et al. 2022

Dig Surg

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Background: Particle therapy (PT) holds a great potential for unresectable hilar cholangiocarcinoma (HC), even though the anatomical proximity to the gastrointestinal tract prevents delivering a radical dose to the tumor. Space-making PT (SMPT), consisting of spacer placement surgery and subsequent PT, has been developed to minimize complications and maximize the therapeutic benefit of dose escalation for HC. This study aimed to examine the effectiveness of SMPT for the treatment of HC. Methods: Between 2007 and 2018, 12 patients with unresectable HC treated with SMPT were enrolled. The treatment outcomes and effectiveness of spacer placement surgery were evaluated through analyses of pre- and post- surgical parameters of dose volume histograms. Results: The median survival time was 29.6 months, and the 1- and 3-year overall survival rates were 82.5% and 45.8%, respectively. The mean V95% value (volume irradiated with 95% of the planned treatment dose) of the gross tumor volume and clinical target volume after spacer placement surgery improved to 98.5% and 96.6% from preoperative values of 85.6% and 78.1%, respectively (p = 0.0196 and p = 0.0053 respectively). Grade 3 or higher adverse events after SMPT were seen in 6 patients. Conclusions: SMPT led to improvements in dosimetric parameters and showed good feasibility and excellent outcomes. SMPT can be a promising novel alternative for unresectable HC.

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Section: Introductionmentioning

confidence: 99%

Space-Making Particle Therapy for Unresectable Hilar Cholangiocarcinoma

Komatsu

Terashima

et al. 2022

Dig Surg

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“…In 2017, Engineer et al reported the outcomes of chemoradiotherapy for unresectable hilar cholangiocarcinoma. Their study showed that the MST of a patient who received chemoradiotherapy (gemcitabine + IMRT at 57 Gy) was 16 months [11]. Moreover, where were some case reports of long-term survival with radiotherapy alone in unresectable hilar cholangiocarcinoma treated.…”

Section: Discussionmentioning

confidence: 99%

Unresectable hilar cholangiocarcinoma treated with chemoradiotherapy: a 9-year survival case

et al. 2020

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Patients with advanced unresectable hilar cholangiocarcinoma have poor prognosis, and the survival is usually short. Herein, we report a 9-year survival case of unresectable hilar cholangiocarcinoma treated with chemoradiotherapy. A 64-year-old male patient presented with hilar cholangiocarcinoma. The tumor was located in the right hepatic duct, and it extended from the bifurcation of the anterior and posterior branches to the periphery. In the left side, the tumor extended from the umbilical portion to B2 and B3. However, there was no distant metastasis. The patient was then diagnosed with locally advanced, unresectable hilar cholangiocarcinoma and was treated with chemoradiotherapy. He received a total dose of 60 Gy in 30 daily fractions via intensity-modulated radiation therapy. In addition, he received gemcitabine chemotherapy for 5 years. There has been neither re-elevation of carbohydrate antigen 19-9 levels nor tumor relapse for 5 years during chemotherapy. Therefore, gemcitabine treatment was discontinued. However, the patient experienced tumor relapse 3 years after the last chemotherapy. Hence, chemotherapy with gemcitabine and cisplatin was initiated. At present, 1 year has passed after treatment for recurrence, and the patient has survived for 9 years since the initial treatment. Herein, we report a rare case of long-term survival with chemoradiotherapy in locally advanced unresectable hilar cholangiocarcinoma.

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“…In another study, chemoradiation followed by a brachytherapy boost in anal cancers resulted in excellent local control and sphincter preservation rates with decreased late toxicities (90). A recent study in patients with unresectable hilar cholangiocarcinoma demonstrated prolonged OS in IMRT with brachytherapy (91). Studies have reported the use of metallic stent and Intraluminal Brachytherapy in type II malignant hilar biliary obstruction (92) and brachytherapy in liver metastases as effective modes of palliation (93).…”

Section: Gastro-intestinal Thoracic and Genitourinary Cancersmentioning

confidence: 99%