Adjuvant Radio-chemotherapy for extrahepatic biliary tract cancers
Adjuvant Radio-chemotherapy for extrahepatic biliary tract cancers
复制标题
DOI：
10.1186/1471-2407-11-267
复制
发表时间：
2011-06-24
期刊：
影响因子：
3.8
通讯作者：
Allal, Abdelkarim S.
中科院分区：
文献类型：
--
作者：
Bonet Beltran, Marta;Roth, Arnaud D.;Allal, Abdelkarim S.
背景资料：肝外胆管癌是一种少见的恶性肿瘤，其特点是预后差，局部复发率高。本研究的目的是评估的可行性和潜在的影响，在一个institution.Methods治疗的一系列患者的辅助放疗（RT）：23例非转移性胆管癌手术治疗的治愈意图（4胆囊，7壶腹和12胆管癌）接受三维适形外束RT的中位数总剂量为50.4Gy。21例患者（91%）接受了基于5-FU的同步化疗。手术切缘阴性11例（48%），狭窄2例（9%），显微镜下受累8例（35%）。11例患者（55%）有转移性淋巴结受累。结果：2例（9%）患者发生急性胃肠道反应（RTOG评分2级），术后随访3-98个月，平均30个月。分别在8例（35%）和2例（9%）患者中观察到1级和2级恶心或呕吐。只有一名患者出现了严重的晚期辐射诱导毒性。复发的主要模式是局部区域和远处（肝，腹膜和/或肺）。根据肿瘤位置，在局部区域控制中未观察到差异。5年精确局部区域控制率为48.3%（阴性和阳性/窄/未知切缘患者分别为67%和30%，p = 0.04）。整个组的5年总生存率为35.9%（阴性切缘为61.4%，阳性/狭窄/未知切缘为16.7%，p = 0.07）。结论：术后放疗50-60戈伊是可行的，急性和晚期毒性可接受。在我们的系列中观察到的潜在益处可能支持在局部晚期疾病患者中使用辅助RT。前瞻性随机试验是必要的，以明确证实RT在这个肿瘤位置的作用。
Background: Extrahepatic biliary duct cancers (EBDC) are uncommon malignancies characterized by a poor prognosis with high rate of loco-regional recurrence. The purpose of the present study is to assess the feasibility and the potential impact of adjuvant radiotherapy (RT) in a series of patients treated in one institution.Methods: Twenty three patients with non-metastatic bile duct cancer treated surgically with curative intent (4 gallbladder, 7 ampullary and 12 cholangiocarcinoma) received 3D conformal external beam RT to a median total dose of 50.4Gy. Concurrent chemotherapy based on 5-FU was delivered to 21 patients (91%). Surgical margins were negative in 11 patients (48%), narrow in 2 (9%), and microscopically involved in 8 (35%). Eleven patients (55%) had metastatic nodal involvement. The average follow-up time for all patients was 30 months (ranging from 3-98).Results: Acute gastrointestinal grade 2 toxicity (RTOG scale) was recorded in 2 patients (9%). Nausea or vomiting grade 1 and 2 was observed in 8 (35%) and 2 patients (9%) respectively. Only one patient developed a major late radiation-induced toxicity. The main pattern of recurrence was both loco-regional and distant (liver, peritoneum and/or lung). No difference was observed in loco-regional control according to the tumor location. The 5-year actuarial loco-regional control rate was 48.3% (67% and 30% for patients operated on with negative and positive/narrow/unknown margins respectively, p = 0.04). The 5-year actuarial overall survival was of 35.9% for the entire group (61.4% in case of negative margins and 16.7% in case of positive/narrow/unknown margins, p = 0.07).Conclusions: Postoperative RT with 50-60 Gy is feasible with acceptable acute and late toxicities. The potential benefit observed in our series may support the use of adjuvant RT in patients with locally advanced disease. Prospective randomized trials are warranted to confirm definitively the role of RT in this tumor location.