Role of radiation after operative palliation in cancer of the proximal bile ducts

Grove, Mark K.; Hermann, Robert E.; Vogt, David; Broughan, Thomas A.

doi:10.1016/0002-9610(91)91111-u

Cited by 58 publications

(22 citation statements)

References 18 publications

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“…There are many studies of improved survival in patients with unresectable bile duct carcinoma treated by EBRT or by a combination of EBRT and brachytherapy, compared with those receiving palliative treatment alone (6,9,24,32,33). A median survival time of 2-4 months was reported in unresectable patients with biliary drainage who received no further therapy.…”

Section: Discussionmentioning

confidence: 99%

Magnitude of Combination Therapy of Radical Resection and External Beam Radiotherapy for Patients With Carcinomas of the Extrahepatic Bile Duct and Gallbladder

et al. 2005

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The present study sought to identify the therapeutic efficacy of adjuvant external beam radiotherapy (EBRT) for carcinomas of the extrahepatic bile duct (EHBD) and gallbladder. Twenty-one patients with pathologically verified EHBD carcinoma and 18 patients with gallbladder carcinoma were analyzed retrospectively by Cox regression analysis for predictors of survival. The overall 5-year survival rates after resection were 33% for EHBD carcinoma and 56% for gallbladder carcinoma. The overall 5-year survival rate for EHBD carcinoma was 60% in 8 patients without microscopic residual disease (R0), 15% in 9 patients with microscopic residual tumor (R1), and 0% in 4 patients with macroscopic residual tumor (R2). The overall 5-year survival rate of gallbladder carcinoma patients was also decreased with R status equal to 73%, 40%, and 0% for R0, R1 and R2, respectively. Adjuvant radiotherapy significantly improved the 5-year survival rate in 7 patients with R1 disease of EHBD carcinoma (P = .035), compared with survival in 2 patients who underwent resection alone. However, no significant difference was noted in the 5-year survival rate between the resection plus EBRT group and the resection alone group for gallbladder carcinoma. Multivariate analysis revealed that histopathologic grade (G) was an independent predictor of survival for EHBD carcinoma and that direct invasion of liver parenchyma was a predictor of survival for gallbladder carcinoma. This study suggests that curative resection provides the best survival for patients with EHBD and gallbladder carcinoma, and that radiotherapy may play a beneficial role in controlling local-regional residual EHBD carcinoma tumors. However, new strategies for adjuvant therapy are needed to improve survival in patients with gallbladder carcinoma.

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Section: Discussionmentioning

confidence: 99%

Magnitude of Combination Therapy of Radical Resection and External Beam Radiotherapy for Patients With Carcinomas of the Extrahepatic Bile Duct and Gallbladder

et al. 2005

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“…Definitive radiation therapy, with or without chemotherapy, improves the median survival of patients who are unresectable from 2 to 4 months to 9 to 12 months 5, 6. Even with locoregional radiation therapy, local recurrence is commonly the first site of progression, and mortality is often associated with the consequences of local tumor growth.…”

Section: Introductionmentioning

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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“…If the patient is being treated by brachytherapy alone, 30 Gy in six fractions over 3 days may be given. In case of BT in conjunction with EBRT (combined radiotherapy), a total dose of up to 20 Gy in four fractions over 2 days can be given (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Gy at 0.5-1 cm from the source with LDR) [3]. Due to the lack of sufficiently large clinical trials it is difficult to estimate the true therapeutic benefit of BT in addition to EBRT.…”

Section: Brachytherapymentioning

confidence: 99%

Radiotherapy and Chemotherapy as Therapeutic Strategies in Extrahepatic Biliary Duct Carcinoma

Brunner

Eccles

2010

Strahlenther Onkol

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Role of radiation after operative palliation in cancer of the proximal bile ducts

Cited by 58 publications

References 18 publications

Magnitude of Combination Therapy of Radical Resection and External Beam Radiotherapy for Patients With Carcinomas of the Extrahepatic Bile Duct and Gallbladder

Magnitude of Combination Therapy of Radical Resection and External Beam Radiotherapy for Patients With Carcinomas of the Extrahepatic Bile Duct and Gallbladder

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

Radiotherapy and Chemotherapy as Therapeutic Strategies in Extrahepatic Biliary Duct Carcinoma

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