PERIHILAR CHOLANGIOCARCINOMA - POSTOPERATIVE RADIOTHERAPY DOES NOT IMPROVE SURVIVAL
PERIHILAR CHOLANGIOCARCINOMA - POSTOPERATIVE RADIOTHERAPY DOES NOT IMPROVE SURVIVAL
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DOI：
10.1097/00000658-199506000-00017
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发表时间：
1995-06-01
影响因子：
9
通讯作者：
CAMERON, JL
中科院分区：
文献类型：
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作者：
PITT, HA;NAKEEB, A;CAMERON, JL
该分析的目的是前瞻性地确定手术切除和放射治疗对肝门周围胆管癌患者生存时间和质量以及晚期毒性的影响。BackgroundRetrospective分析表明，辅助放射治疗可提高肝门周围胆管癌患者的生存率。然而，在这些报告中，接受放射治疗的患者往往有较小的，通常可切除的肿瘤，并且相对健康。相比之下，没有接受放射治疗的患者往往有不可切除的肿瘤，转移性疾病，或性能较差的status.MethodsFrom 1988年至1993年，手术分期患者肝门周围胆管癌和1）没有转移性疾病的证据，2）Karnofsky评分>60，3）没有以前的恶性肿瘤或放疗，和4）专利的主要门静脉进行了分析。将50例患者按切除（n = 31）与手术姑息（n = 19）以及放疗（n = 23）与不放疗（n = 27）分层。（1.9 +/- 2.8 vs. 2.4 +/- 2.1 cm，p < 0.01），不太可能侵犯肝动脉（3% vs. 42%，p < 0.05）或门静脉（6% vs. 53%，p < 0.05）。可能影响结果的多个参数在接受和未接受放射治疗的患者之间相似。切除术延长了生存时间（24.2 +/- 2.5 vs. 11.3 +/- 1.0个月，p < 0.05）和生存质量。辐射没有影响的长度（18.4 + 2.9与20.1 +/- 2.4个月）或生存质量或晚期toxic.ConclusionsThis分析表明，在局部肝门周围胆管癌患者，切除术后生存，而辐射没有影响生存或晚期毒性。因此，需要新的药物或策略来提供辅助治疗，以提高这些患者的生存率。
ObjectiveThe aims of this analysis were to determine prospectively the effects of surgical resection and radiation therapy on the length and quality of survival as well as late toxicity in patients with perihilar cholangiocarcinoma.BackgroundRetrospective analyses have suggested that adjuvant radiation therapy improves survival in patients with perihilar cholangiocarcinoma. However, in these reports, patients receiving radiotherapy tended to have smaller, often resectable tumors, and were relatively fit. In comparison, patients who have not received radiotherapy often had unresectable tumors, metastatic disease, or poor performance status.MethodsFrom 1988 through 1993, surgically staged patients with perihilar cholangiocarcinoma and 1) no evidence of metastatic disease, 2) Karnofsky score >60, 3) no prior malignancy or radiotherapy, and 4) a patent main portal Vein were analyzed. Fifty patients were stratified by resection (n = 31) versus operative palliation (n = 19) and by radiation (n = 23) versus no radiotherapy (n = 27).ResultsPatients undergoing resection had smaller tumors (1.9 +/- 2.8 vs. 2.4 +/- 2.1 cm, p < 0.01)that were less likely to invade the hepatic artery (3% vs. 42%, p < 0.05) or portal Vein (6% vs. 53%, p < 0.05). Multiple parameters that might have affected outcome were similar between patients who did and did not receive radiation therapy. Resection improved the length (24.2 +/- 2.5 vs. 11.3 +/- 1.0 months, p < 0.05) and quality of survival. Radiation had no effect on the length (18.4 + 2.9 vs. 20.1 +/- 2.4 months) or quality of survival or on late toxicity.ConclusionsThis analysis suggests that in patients with localized perihilar cholangiocarcinoma, resection prolongs survival whereas radiation has no effect on either survival or late toxicity. Thus, new agents or strategies to deliver adjuvant therapy are needed to improve survival in these patients.