RADIATION THERAPY IS ASSOCIATED WITH IMPROVED SURVIVAL IN THE ADJUVANT AND DEFINITIVE TREATMENT OF INTRAHEPATIC CHOLANGIOCARCINOMA
RADIATION THERAPY IS ASSOCIATED WITH IMPROVED SURVIVAL IN THE ADJUVANT AND DEFINITIVE TREATMENT OF INTRAHEPATIC CHOLANGIOCARCINOMA
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DOI：
10.1016/j.ijrobp.2008.03.018
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发表时间：
2008-12-01
影响因子：
7
通讯作者：
Metz, James M.
中科院分区：
文献类型：
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作者：
Shinohara, Eric T.;Mitra, Nandita;Metz, James M.
目的：肝内胆管癌（IHC）是一种罕见的肿瘤，目前尚无关于放射治疗的大型随机研究。本研究的目的是探讨辅助和确定性放射治疗的作用，在治疗IHC在一大群patients.Methods和Materials：这是一个回顾性分析3,839例IHC收集的监测，流行病学和最终结果（SEER）数据库。结果：患者接受单纯手术治疗（25%）、单纯放疗（10%）、手术加放疗（7%）或未接受任何治疗（58%）。患者人群的中位年龄为73岁（范围：22-102岁）; 52%的患者为男性，81%为白人。手术和辅助放疗、单纯手术、单纯放疗和未治疗的中位OS分别为11（95%置信区间[CI]，913）、6（95% CI，5-6）、7（95% CI，6-8）和3个月。单纯手术与手术+辅助放疗（p = 0.014）和单纯放疗与未治疗（p < 0.0001）之间的OS存在显著差异。多变量分析显示，与未治疗相比，手术和辅助放疗对OS的获益最大（HR = 0.40; 95% CI，0.34-0.47），其次是单纯手术（风险比[HR]，0.49; 95% CI，0.44-0.54）和单纯放疗（HR，0.68; 95% CI，0.59-0.77）。倾向评分校正的风险比（控制年龄、种族/民族、分期和诊断年份）也很显着（手术和辅助放疗对比单独手术（HR，0.82; 95% CI，0.70-0.96）;单独放疗对比未治疗）结论：研究结果表明，虽然治愈率仍然很低，但辅助和确定性放射治疗可以延长生存期。未来的研究应评估在IHC治疗中加入化疗和生物制剂。(c)2008年爱思唯尔公司
Purpose: Intrahepatic cholangiocarcinomas (IHC) are rare tumors for which large randomized studies regarding the use of radiation are not available. The purpose of this study was to examine the role of adjuvant and definitive radiation therapy in the treatment of IHC in a large group of patients.Methods and Materials: This is a retrospective analysis of 3,839 patients with IHC collected from the Surveillance, Epidemiology, and End Results (SEER) database. The primary endpoint was overall survival (OS).Results: Patients received either surgery alone (25%), radiation therapy alone (10%), surgery and adjuvant radiation therapy (7%) or no treatment (58%). The median age of the patient population was 73 years (range, 22-102 years); 52% of patients were male and 81% were Caucasian. Median OS was 11 (95% confidence interval [CI], 913), 6 (95% CI, 5-6), 7 (95% CI, 6-8), and 3 months for surgery and adjuvant radiation therapy, sugery alone, radiation therapy alone, and no treatment, respectively. The OS was significantly different between surgery alone and surgery and adjuvant radiation therapy (p = 0.014) and radiation therapy alone and no treatment (p < 0.0001). Use of surgery and adjuvant radiation therapy conferred the greatest benefit on OS (HR = 0.40; 95% CI, 0.34-0.47), followed by surgery alone (hazard ratio [HR], 0.49; 95% CI, 0.44-0.54) and radiation therapy alone (HR, 0.68; 95% CI, 0.59-0.77) compared with no treatment, on multivariate analysis. Propensity score adjusted hazard ratios (controlling for age, race/ethnicity, stage, and year of diagnosis) were also significant (surgery and adjuvant radiation therapy vs. surgery alone (HR, 0.82; 95% CI, 0.70-0.96); radiation therapy alone vs. no treatment (HR, 0.67; 95% CI, 0.58-0.76)).Conclusions: The study results suggest that adjuvant and definitive radiation treatment prolong survival, although cure rates remain low. Future studies should evaluate the addition of chemotherapy and biologics to the treatment of IHC. (c) 2008 Elsevier Inc.