The role of radiotherapy in the management of extrahepatic bile duct cancer: An analysis of 145 consecutive patients treated with intraluminal and/or external beam radiotherapy

Kamada, Tadashi; Saitou, H.; Takamura, Akira; Nojima, Takayuki; Okushiba, Shunichi

doi:10.1016/0360-3016(95)02132-9

Cited by 99 publications

(62 citation statements)

References 20 publications

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“…The prognosis is typically poor. Multiple studies have demonstrated the potential efficacy of radiotherapy, with and without chemosensitization, as palliative therapy [1,2] and neoadjuvant therapy prior to conventional resection [3] . Recently, it was reported that liver transplantation with neoadjuvant CRT is more effective than resection for cholangiocarcinoma [4] .…”

Section: Discussionmentioning

confidence: 99%

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma

Hayano

Miura²,

Amano³

et al. 2010

WJR

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Significant hemobilia due to arterio-biliary fistula is a very rare complication of chemoradiation therapy (CRT) for unresectable intrahepatic cholangiocarcinoma (ICC).Here we report a case of arterio-biliary fistula after CRT for unresectable ICC demonstrated by angiographic examinations. This fistula was successfully treated by endovascular embolization. Hemobilia is a rare complication, but arterio-biliary fistula should be considered after CRT of ICC.

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Section: Discussionmentioning

confidence: 99%

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma

Hayano

Miura²,

Amano³

et al. 2010

WJR

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“…The sensitivity of this cancer to radiochemotherapy [53][54][55] seems to be higher than expected from trials of radiotherapy or chemotherapy alone. 17,18,56 The single patient who had a minor response to aggressive chemotherapy after 5 cycles of PDT suggests that combination of PDT and chemotherapy may become feasible.…”

Section: Figmentioning

confidence: 99%

“…2,5 Survival with nonresectable tumor lasts for a median of 3 months without intervention and 4 to 6 months with biliary drainage. [11][12][13][14][15] Given the longer hospitalization time, the adverse effects, and the marginal life extension with anticancer therapies, 2,[16][17][18] usual palliation still is biliary drainage only.…”

mentioning

confidence: 99%

Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

et al. 2000

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Median survival time of nonresectable hilar bile duct cancer is only 4 to 6 months owing to tumor spread in the biliary tree, refractory cholestasis, and sepsis or liver failure. We explored whether local photodynamic therapy of nonresectable bile duct cancer could improve survival. A sample size of 23 patients is required to detect an increase in 6-month survival rate from less than 50% to greater than 70% in a single-arm phase-II trial with a statistical power of 80% (Fleming's single step procedure; ␣ ‫؍‬ 0.05). Twentythree consecutive patients (8 women, 15 men; 67 ؎ 14 years) with nonresectable bile duct cancer (Bismuth type III n ‫؍‬ 2, type IV n ‫؍‬ 21) were treated with photodynamic therapy and biliary endoprosthesis. Photofrin (QLT Pharmaceuticals, Vancouver, Canada) (2 mg/kg body weight intravenously) was photoactivated after 1 to 4 days with laser light (630 nm; 242 J/cm 2 ) via endoscopic retrograde access. The 6-month survival rate was 91% after diagnosis and 74% after start of photodynamic therapy (30-day mortality rate was 4%) at a median follow-up time of 10.3 months after diagnosis. Causes of death were tumor progression (n ‫؍‬ 9) and bacterial infections (n ‫؍‬ 4). The median rate of local tumor response was 74%, 54%, 29%, and 67% after the first, second, third, fourth, and fifth photodynamic therapy. Time to progression ranged from 3 to 8 months. All patients, except 1 with diffuse liver metastases, improved in cholestasis, performance, and quality of life. Photodynamic therapy can prevent tumor occlusion of hilar bile ducts. The apparent benefit in survival time should be confirmed in a controlled trial versus palliation by endoprosthesis only. (HEPATOLOGY 2000;31:291-298.)Hilar bile duct cancer is fraught with a very poor prognosis. 1,2 Tumors limited to the common bile duct, the bifurcation, or the bifurcation and the intrahepatic ducts of either the right or left lobe, types I, II, IIIa, and IIIb according to Bismuth, 3 may be curatively resectable with a 5-year survival rate of 9% to 21%, 4-8 and 26% to 30% in selected series. 9,10

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“…Better outcomes with higher doses have led many to the practice of using brachytherapy as a boost to EBRT. Several retrospective series have shown a progression-free and overall survival benefit with the addition of brachytherapy to EBRT (13)(14)(15)(16)(17). One of the proposed mechanisms in these small studies was felt to be secondary to increasing longevity of stent patency (17,24).…”

Section: Discussionmentioning

confidence: 99%

“…When utilized, external beam radiation therapy (EBRT) can be delivered with or without a brachytherapy boost (11,12). Combining EBRT with brachytherapy allows for the delivery of an elective dose to larger areas, including nodal basins when desired, while delivering a more definitive dose to the tumor that doesn't tend to increase dose to organs at risk (13)(14)(15)(16)(17)(18). The benefit of EBRT in combination with brachytherapy has been previously evaluated in multiple single-institution retrospective series with the majority either showing an overall survival or progression-free survival benefit (13)(14)(15)(16)(17)19).…”

Section: Introductionmentioning

confidence: 99%

Comparison of external beam radiation and brachytherapy to external beam radiation alone for unresectable extrahepatic cholangiocarcinoma

Boothe

Hopkins

Frandsen

et al. 2016

J. Gastrointest. Oncol.

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Background: Extrahepatic cholangiocarcinoma (EHC) is a rare malignancy with a relatively poor prognosis. There are no randomized, prospective data to help define the optimal method of radiation delivery for unresectable EHC. The purpose of this study was to evaluate the benefit of adding brachytherapy to external beam radiation therapy (EBRT) for unresectable EHC. Methods: A retrospective review of 1,326 patients with unresectable EHC using the Surveillance, Epidemiology, and End Results (SEER) database was completed. Kaplan-Meier methods were used to analyze the primary endpoint, overall survival. Univariate and multivariate analysis was performed to identify and control for potential confounding variables, including age at diagnosis, sex, stage, grade, histology, race, year of diagnosis, and reason for no surgery. Results: Of the 1,326 patients with unresectable EHC, 1,188 (92.9%) received EBRT only, while 91 (7.1%) received both EBRT and brachytherapy. Patients receiving combined modality radiation therapy were more likely to be treated prior to the year 2000. Median overall survival for patients receiving EBRT and EBRT plus brachytherapy was 9 and 11 months, respectively (P=0.04). Cause specific survival was 12 months for those receiving EBRT only, and 15 months for those who received EBRT + brachytherapy (P=0.10). Survival analysis performed on patients with locoregional disease only revealed a trend towards prolonged overall survival with those receiving EBRT + brachytherapy (P=0.08). Multivariate analysis revealed grade and stage of disease were correlated with both overall survival and cause specific survival (P≤0.05).Conclusions: Among patients with unresectable EHC, the addition of brachytherapy to EBRT is associated with a prolonged median overall survival. However, the use of brachytherapy boost decreased in the last decade of the study.

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The role of radiotherapy in the management of extrahepatic bile duct cancer: An analysis of 145 consecutive patients treated with intraluminal and/or external beam radiotherapy

Cited by 99 publications

References 20 publications

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma

Arterio-biliary fistula as rare complication of chemoradiation therapy for intrahepatic cholangiocarcinoma

Photodynamic therapy for advanced bile duct cancer: Evidence for improved palliation and extended survival

Comparison of external beam radiation and brachytherapy to external beam radiation alone for unresectable extrahepatic cholangiocarcinoma

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