Stereotactic body radiation therapy in cholangiocarcinoma: a systematic review

Abstract

Cholangiocarcinoma (CC) is an uncommon neoplasm representing 3% of gastrointestinal (GI) cancers and the second most common primary liver malignancy. 1 They represent a very heterogeneous group of neoplasm arising from the epithelial cells of the bile duct. CC are classified according to their anatomical location as intra hepatic or extra hepatic. Radical surgery with negative histological margins is the only treatment allowing long-term survival but even after tumor resection, the prognosis is dismal with 5 year overall survival (OS) <20%. 1 Moreover, most of these patients have advanced disease at the time of diagnosis and are candidates for non-surgical treatments. Furthermore, in patients undergoing surgery, 15 to 25% microscopic (R1) or macroscopic (R2) residual disease was reported. 2 Some studies have demonstrated that external beam radiotherapy (EBRT) with or without systemic chemotherapy (CHT) is a treatment option in unresectable or R1-R2 residual CC with median OS ranging between 10 and 15 months. [3][4][5] Furthermore, a significant correlation between radiotherapy (RT) dose and OS has been reported. [6][7][8] However, the possibility to deliver very high RT dose on this site is limited by the low radiation tolerance of both liver and GI tract.In the last decade, technological improvements in EBRT delivery accuracy and in respiratory motion compensation has enabled the widespread implementation of stereotactic body radiation therapy (SBRT). Particularly, due to its ability to deliver a high and focused dose in few

Examining the use of radiation therapy for cholangiocarcinoma: benefits through modern techniques

“…Despite the dismal prognosis, one patient in our cohort who underwent radical hemihepatectomy followed by adjuvant chemotherapy and hypofractionated RT was still alive at the end of follow-up 6.6 years after initiation of RT, encouraging the use of combined modality treatment. Radical surgery remains the cornerstone of local therapy and constitutes a favorable prognostic factor (1,4,6,17).…”

“…External beam radiotherapy (RT) can be used in the de nitive or adjuvant treatment setting, ameliorating survival signi cantly (1,4,17,18). Data from the Surveillance, Epidemiology, and End Results (SEER) database demonstrate an improvement of cancer speci c survival for de nitive RT (19).…”

The Evolving Role of Radiation Therapy in the Treatment of Biliary Tract Cancer

“…There is emerging evidence concerning the efficacy of stereotactic body radiotherapy (SBRT) in the treatment of inoperable BTC. Several prospective and retrospective studies SBRT led to local control rates ranging between 65 and 100% with a median OS of 11-35.5 years (median 15 months), in selected patients (176)(177)(178). In a systematic review, including 10 studies and 231 patients, the pooled 1 year LC was 83.4% (95% CI: 76.5-89.4%) (178).…”

“…Several prospective and retrospective studies SBRT led to local control rates ranging between 65 and 100% with a median OS of 11-35.5 years (median 15 months), in selected patients (176)(177)(178). In a systematic review, including 10 studies and 231 patients, the pooled 1 year LC was 83.4% (95% CI: 76.5-89.4%) (178). According to the anatomical location of CCA, 1 year OS was 57.1% (range: 45.0-58.0%), 81.5% (range: 80.0-83.0%), and 58.7% (range: 45.0-73.0%) in studies including iCCA, eCCA, and both sites, respectively (126,(178)(179)(180)(181)(182)(183)(184)(185)(186)(187).…”

“…In a systematic review, including 10 studies and 231 patients, the pooled 1 year LC was 83.4% (95% CI: 76.5-89.4%) (178). According to the anatomical location of CCA, 1 year OS was 57.1% (range: 45.0-58.0%), 81.5% (range: 80.0-83.0%), and 58.7% (range: 45.0-73.0%) in studies including iCCA, eCCA, and both sites, respectively (126,(178)(179)(180)(181)(182)(183)(184)(185)(186)(187). Furthermore, in several studies dose escalation correlated with prolonged OS and LC (175,177).…”