External-beam radiotherapy for localized extrahepatic cholangiocarcinoma
External-beam radiotherapy for localized extrahepatic cholangiocarcinoma
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DOI：
10.1016/j.ijrobp.2006.05.061
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发表时间：
2006-11-01
影响因子：
7
通讯作者：
Ben-Josef, Edgar
中科院分区：
文献类型：
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作者：
Ben-David, Merav A.;Griffith, Kent A.;Ben-Josef, Edgar
目的：放射治疗（RT）在肝外胆管癌（EHCC）中的作用尚不清楚，只有有限的报告存在关于使用这种方式。我们回顾了我们的机构经验，以确定潜在治愈性切除术后患者的失败模式，以及辅助RT后和不可切除患者的预期结局。在机构审查委员会批准后，81名诊断为EHCC的患者（胆囊28例，远端胆管24例，肝门29例）。28例患者（35%）接受了R 0/R1切缘的潜在治愈性切除。52例患者（64%）不可切除或切除后出现肉眼可见残留病变（R2）。所有患者均接受了三维计划兆伏RT。使用线性二次形式主义和α/β比为10，将每位患者的剂量转换为2戈伊/分次的等效总剂量。输送的中位剂量为58.4戈伊（范围，23-88.2戈伊）。结果：随访中位时间为1.2年（范围0.1-9.8年），75例（93%）患者死亡。中位总生存期（OS）和无进展生存期（PFS）分别为14. 7（95% CI，13. 1 - 16. 3）和11（95% CI，7. 6 - 13. 2）个月。三个疾病部位之间的OS（p = 0.70）或PFS（p = 0.80）无差异。完全切除（R 0）是与OS和PFS增加显著相关的唯一预测因素（p = 0.002），R1和R2切除之间的结局无差异。失败的第一个网站主要是locoregional（68.8%的所有失败）。结论：局部失败是EHCC的一个主要问题，这表明需要更强烈的辐射时间表和更好的放射增敏策略。由于R1切除似乎没有带来任何益处，因此似乎只有在R 0切除可能时才应考虑手术。新辅助治疗可能更好地服务于边缘可切除的患者。(c)2006年爱思唯尔公司
Purpose: The role of radiation therapy (RT) in extrahepatic cholangiocarcinoma (EHCC) is not clear and only limited reports exist on the use of this modality. We have reviewed our institutional experience to determine the pattern of failure in patients after potentially curative resection and the expected outcomes after adjuvant RT and in unresectable patients.Methods and Materials: After institutional review board approval, 81 patients diagnosed with EHCC (gallbladder 28, distal bile duct 24, hilar 29) between June 1986 and December 2004 were identified and their records reviewed. Twenty-eight patients (35%) underwent potentially curative resection with R0/R1 margins. Fifty-two patients (64%) were unresectable or underwent resection with macroscopic residual disease (R2). All patients received three-dimensional planned megavoltage RT. The dose for each patient was converted to the equivalent total dose in a 2 Gy/fraction, using the linear-quadratic formalism and alpha/beta ratio of 10. The median dose delivered was 58.4 Gy (range, 23-88.2 Gy). 54% received concomitant chemotherapy.Results: With a median follow-up time of 1.2 years (range, 0.1-9.8 years) 75 patients (93%) have died. Median overall survival (OS) and progression-free survival (PFS) were 14.7 (95% CI, 13.1-16.3) and 11 (95% CI, 7.6-13.2) months, respectively. There was no difference among the three disease sites in OS (p = 0.70) or PFS (p = 0.80). Complete resection (R0) was the only predictive factor significantly associated with increase in both OS and PFS (p = 0.002), and there was no difference in outcomes between R1 and R2 resections. The first site of failure was predominantly locoregional (68.8% of all failures).Conclusion: Local failure is a major problem in EHCC, suggesting the need for more intense radiation schedules and better radiosensitizing strategies. Because R1 resection appears to convey no benefit, it appears that surgery should be contemplated only when an R0 resection is likely. Borderline-resectable patients might be better served by neoadjuvant therapy. (c) 2006 Elsevier Inc.