Radiation therapy for biliary tract tumors: the joint experience of three centers

Radiation therapy for biliary tract tumors: the joint experience of three centers

Background/aim: This study presents the joint experience of three centers in the treatment of patients with biliary tract tumors with radiation therapy (RT). Materials and methods: The records of 27 patients were retrospectively reviewed. All of the patients who had undergone surgical resection received postoperative adjuvant RT, whereas all of the patients who had not undergone a surgical resection received RT with palliative intent. Twenty patients with adequate performance status were treated with RT and chemotherapy, while the remaining seven patients were treated with RT alone. Results: Follow-up ranged from 1 to 44 months. Local control was not achieved in 10 out of 11 patients who had received RT with palliative intent. Systemic failure was observed in eight patients at 5 to 16 months. Fifteen patients died due to disease-related causes at 1 to 22 months. At 2 years, overall survival was 33% and disease-free survival was 19%. A surgical resection with curative intent predicted improved local failure-free survival and improved disease-free survival. Conclusion: Since local recurrence is still the leading cause of failure following postoperative RT and the outcome following palliative RT is far from satisfactory, the indications, the target volume, and the doses for RT should be reconsidered.

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  • 1. Chapman RW. Risk factors for biliary tract carcinogenesis. Ann Oncol 1999; 10: 308-311.
  • 2. Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996; 224: 463-473.
  • 3. Yee K, Sheppard BC, Domreis J, Blanke CD. Cancers of the gallbladder and biliary ducts. Oncology (Williston Park) 2002; 16: 939-957.
  • 4. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York, NY, USA: Springer; 2010.
  • 5. Daines WP, Rajagopalan V, Grossbard ML, Kozuch P. Gallbladder and biliary tract carcinoma: a comprehensive update, Part 2. Oncology (Williston Park) 2004; 18: 1049-1059.
  • 6. Lang H, Sotiropoulos GC, Frühauf NR, Dömland M, Paul A, Kind EM, Malagó M, Broelsch CE. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg 2005; 241: 134-143.
  • 7. Todoroki T, Gunderson LL, Nagorney DM. Biliary tract IORT. In: Gunderson LL, Willett CG, Harrison LB, editors. Intraoperative Irradiation: Techniques and Results. Totowa, NJ, USA: Humana Press; 1999.
  • 8. Jarnagin WR, Ruo L, Little SA, Klimstra D, D’Angelica M, DeMatteo RP, Wagman R, Blumgart LH, Fong Y. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 2003; 98: 1689-1700.
  • 9. Kopelson G, Harisiadis L, Tretter P, Chang CH. The role of radiation therapy in cancer of the extra-hepatic biliary system: an analysis of thirteen patients and a review of the literature of the effectiveness of surgery, chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 1977; 2: 883-894.
  • 10. Macdonald JS. Gastric cancer—New therapeutic options. N Engl J Med 2006; 355: 76-77.
  • 11. Nelson JW, Ghafoori AP, Willett CG, Tyler DS, Pappas TN, Clary BM, Hurwitz HI, Bendell JC, Morse MA, Clough RW et al. Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2009; 73: 148-153.
  • 12. Vern-Gross TZ, Shivnani AT, Chen K, Lee CM, Tward JD, MacDonald OK, Crane CH, Talamonti MS, Munoz LL, Small W Jr. Survival outcomes in resected extrahepatic cholangiocarcinoma: effect of adjuvant radiotherapy in a surveillance, epidemiology, and end results analysis. Int J Radiat Oncol Biol Phys 2011; 81: 189-198.
  • 13. Shinohara ET, Mitra N, Guo M, Metz JM. Radiation therapy is associated with improved survival in the adjuvant and definitive treatment of intrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2008; 72: 1495-1501.
  • 14. Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 1969; 2: 865-867.
  • 15. Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985; 120: 899-903.
  • 16. Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T; Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 2002; 95: 1685-1695.
  • 17. Kim K, Chie EK, Jang JY, Kim SW, Han SW, Oh DY, Im SA, Kim TY, Bang YJ, Ha SW. Adjuvant chemoradiotherapy after curative resection for extrahepatic bile duct cancer: a longterm single center experience. Am J Clin Oncol 2012; 35: 136- 140.
  • 18. Ohnishi H, Asada M, Shichijo Y, Iijima N, Itobayashi E, Shimura K, Suzuki T, Yoshida S, Mine T. External radiotherapy for biliary decompression of hilar cholangiocarcinoma. Hepatogastroenterology 1995; 42: 265-268.
  • 19. Cameron JL, Pitt HA, Zinner MJ, Kaufman SL, Coleman J. Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg 1990; 159: 91-97.
  • 20. Crane CH, Macdonald KO, Vauthey JN, Yehuda P, Brown T, Curley S, Wong A, Delclos M, Charnsangavej C, Janjan NA. Limitations of conventional doses of chemoradiation for unresectable biliary cancer. Int J Radiat Oncol Biol Phys 2002; 53: 969-974.
  • 21. Mahe M, Romestaing P, Talon B, Ardiet JM, Salerno N, Sentenac I, Gerard JP. Radiation therapy in extrahepatic bile duct carcinoma. Radiother Oncol 1991; 21: 121-127.
  • 22. Hayes JK Jr, Sapozink MD, Miller FJ. Definitive radiation therapy in bile duct carcinoma. Int J Radiat Oncol Biol Phys 1988; 15: 735-744.