Efficacy and Safety of External-beam Radiation Therapy for Unresectable Primary or Local Recurrent Cholangiocarcinoma

Takashi Murakami; Rihito Aizawa; Yukinori Matsuo; Hideki Hanazawa; Kojiro Taura; Akihisa Fukuda; Norimitsu Uza; Masahiro Shiokawa; Masashi Kanai; Etsuro Hatano; Hiroshi Seno; Manabu Muto; Takashi Mizowaki

doi:10.21873/cdp.10153

Efficacy and Safety of External-beam Radiation Therapy for Unresectable Primary or Local Recurrent Cholangiocarcinoma

Cancer Diagn Progn. 2022 Nov 3;2(6):634-640. doi: 10.21873/cdp.10153. eCollection 2022 Nov-Dec.

Authors

Takashi Murakami¹, Rihito Aizawa¹, Yukinori Matsuo¹, Hideki Hanazawa^{1

2}, Kojiro Taura^{3

4}, Akihisa Fukuda⁵, Norimitsu Uza⁵, Masahiro Shiokawa⁵, Masashi Kanai⁶, Etsuro Hatano³, Hiroshi Seno⁵, Manabu Muto⁶, Takashi Mizowaki¹

Affiliations

¹ Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Radiation Oncology, Kurashiki Central Hospital, Okayama, Japan.
³ Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁴ Department of Gastroenterological Surgery and Oncology, Kitano Hospital Medical Research Institute, Osaka, Japan.
⁵ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Abstract

Background/aim: Treatment options for unresectable cholangiocarcinoma are limited. The aim of the study was to evaluate the clinical outcomes of definitive external-beam radiation therapy (EBRT) for patients with unresectable cholangiocarcinoma.

Patients and methods: Patients with unresectable primary cholangiocarcinoma, or local recurrent cholangiocarcinoma after primary surgery, without distant metastasis who received definitive EBRT (≥45 Gy) between January 2006 and December 2020 at our Institution were analyzed retrospectively. EBRT was basically performed using conventional fractionation (1.8-2 Gy per fraction). Prophylactic nodal irradiation was not performed.

Results: A total of 21 consecutive patients were analyzed: 7 primary and 14 recurrent cases. The median age was 70 (range=38-85) years at initiation of EBRT. A median dose of 54 (range=45-60) Gy comprising 1.8 (range=1.8-3) Gy per fraction was administered to the primary/recurrent local tumor site. The median follow-up period was 21.6 months. The 2-year overall survival, cause-specific survival, progression-free survival, and local recurrence-free rates were 35.7, 35.7, 16.1, and 32.7%, respectively. Long-term local control (>2 years after EBRT) was achieved in 19.0%. Grade 3 toxicities related to EBRT were observed in 4.8% (duodenum hemorrhage). No grade 4 or higher toxicities were observed.

Conclusion: Definitive EBRT for unresectable cholangiocarcinoma was feasible and achieved long-term local control in a subset of patients. As the avoidance of local recurrence may lead to the benefits of prolonging biliary patency and subsequently alleviating the need for an invasive procedure for biliary drainage, EBRT could be one sustainable therapeutic option for patients with unresectable cholangiocarcinoma.

Keywords: Cholangiocarcinoma; radiation therapy; unresectable.