Radiotherapy or Chemoradiation in Unresectable Biliary Cancer: A Retrospective Study

Silvia Bisello, Milly Buwenge, Andrea Palloni, Rosa Autorino, Francesco Cellini, Gabriella Macchia, Francesco Deodato, Savino Cilla, Giovanni Brandi, Luca Tagliaferri, Silvia Cammelli, Vincenzo Valentini, Alessio G Morganti, Gian C Mattiucci

Research output: Contribution to journalArticle

Abstract

BACKGROUND/AIM: To retrospectively evaluate the outcome of patients with unresectable biliary cholangiocarcinoma (CC) treated with radiotherapy (RT) plus/minus chemotherapy (CHT).

MATERIALS AND METHODS: Data of patients with intrahepatic CC (ICC), Klatskin's tumor (KT), distal extrahepatic CC (ECC), and gallbladder cancer (GBC) diagnosed from 1991 to 2017 were retrospectively analyzed. The treatment was mainly based on RT plus concurrent CHT +/- brachytherapy (BRT) boost. The Kaplan-Meier method was used to calculate survival curves that were compared using the log-rank test.

RESULTS: Seventy-six patients were included in this analysis (males: 59%; females: 41%; median age: 66.5 years). A minority of patients (7.9%) were treated for disease recurrence after surgery. According to TNM, 78.5% of patients had T stage >3 and 77.6% of patients were treated with concurrent CHT-RT while 22.3% received RT followed by sequential CHT. Median RT dose was 50 Gy (range: 16-75 Gy) delivered with conventional fractionation. CHT was based on Gemcitabine or 5-fluorouracil. BRT was prescribed to 51.3% of patient with a median dose of 14 Gy. Reported Grade ≥3 acute GI and hematological toxicity were 13.2% and 8.1%, respectively. No other severe acute toxicities were reported. One- and 2-year overall survival (OS) were 58.1% and 25.8%, respectively (median: 13.5 months), while 1- and 2-year progression-free survival (PFS) were 43.4% and 9.4%, respectively. None of the following variables had a significant impact on OS and PFS: BRT boost, tumor site, concurrent CHT, and the drugs used in concurrent CHT. In contrast, patients receiving RT with 2D technique showed a PFS significantly higher compared to patients treated with the 3D technique (median: 15.5 vs. 8.5 months; p=0.02).

CONCLUSION: Combined modality treatment (RT+CHT±BRT) in unresectable biliary cancer was associated with acceptable toxicity and OS comparable to the actual standard treatment (CHT). The significantly improved PFS in patients undergoing 2D-RT raises doubts regarding the adequacy of target delineation in these neoplasms.

Original languageEnglish
Pages (from-to)3095-3100
Number of pages6
JournalAnticancer Research
Volume39
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Antimetabolites, Antineoplastic/administration & dosage
  • Bile Duct Neoplasms/mortality
  • Brachytherapy/adverse effects
  • Chemoradiotherapy/adverse effects
  • Cholangiocarcinoma/mortality
  • Deoxycytidine/administration & dosage
  • Dose Fractionation, Radiation
  • Female
  • Fluorouracil/administration & dosage
  • Gallbladder Neoplasms/mortality
  • Humans
  • Klatskin Tumor/mortality
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Progression-Free Survival
  • Retrospective Studies
  • Risk Factors
  • Time Factors

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