Top

BMC Cancer

Published in:

Open Access 01-12-2010 | Research article

Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients

Authors: Yi-Xing Chen, Zhao-Chong Zeng, Zhao-You Tang, Jia Fan, Jian Zhou, Wei Jiang, Meng-Su Zeng, Yun-Shan Tan

Published in: BMC Cancer | Issue 1/2010

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) is the second most common type of primary liver cancer. Only few studies have focused on palliative radiotherapy used for patients who weren't suitable for resection by surgery. This study was conducted to investigate the effect of external beam radiotherapy (EBRT) for patients with unresectable ICC.

Methods

We identified 84 patients with ICC from December 1998 through December 2008 for retrospective analysis. Thirty-five of 84 patients received EBRT therapy five times a week (median dose, 50 Gy; dose range, 30-60 Gy, in fractions of 1.8-2.0 Gy daily; EBRT group); the remaining 49 patients comprised the non-EBRT group. Tumor response, jaundice relief, and survival rates were compared by Kaplan-Meier analysis. Patient records were reviewed and compared using Cox proportional hazard analysis to determine factors that affect survival time in ICC.

Results

After EBRT, complete response (CR) and partial response (PR) of primary tumors were observed in 8.6% and 28.5% of patients, respectively, and CR and PR of lymph node metastases were observed in 20% and 40% of patients. In 19 patients with jaundice, complete and partial relief was observed in 36.8% and 31.6% of patients, respectively. Median survival times were 5.1 months for the non-EBRT group and 9.5 months for the EBRT group (P = 0.003). One-and two-year survival rates for EBRT versus non-EBRT group were 38.5% versus 16.4%, and 9.6% versus 4.9%, respectively. Multivariate analysis revealed that clinical symptoms, larger tumor size, no EBRT, multiple nodules and synchronous lymph node metastases were associated with poorer prognosis.

Conclusions

EBRT as palliative care appears to improve prognosis and relieve the symptom of jaundice in patients with unresectable ICC.

Available only for authorised users

Shaib YH, Davila JA, McGlynn K, et al: Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase?. J Hepatol. 2004, 40: 472-477. 10.1016/j.jhep.2003.11.030.CrossRefPubMed

Ikai I, Itai YJ, Okita K, et al: Report of the 15th follow-up surgery of primary liver cancer. Hepatology Res. 2004, 28: 21-29. 10.1016/j.hepres.2003.08.002.CrossRef

Weber SM, Jarnagin WR, Klimstra D, et al: Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg. 2001, 193: 384-391. 10.1016/S1072-7515(01)01016-X.CrossRefPubMed

Saxena A, Chua TC, Sarkar A, et al: Clinicopathologic and treatment-related factors influencing recurrence and survival after hepatic resection of intrahepatic cholangiocarcinoma: a 19-year experience from an established Australian hepatobiliary unit. J Gastrointest Surg. 2010, 14 (7): 1128-38. 10.1007/s11605-010-1203-1.CrossRefPubMed

Lang H, Sotiropoulos GC, Sgourakis G, et al: Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg. 2009, 208 (2): 218-28. 10.1016/j.jamcollsurg.2008.10.017.CrossRefPubMed

Choi SB, Kim KS, Choi JY, et al: The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol. 2009, 16 (11): 3048-56. 10.1245/s10434-009-0631-1.CrossRefPubMed

Fu XH, Tang ZH, Zong M, et al: Clinicopathologic features, diagnosis and surgical treatment of intrahepatic cholangiocarcinoma in 104 patients. Hepatobiliary Pancreat Dis Int. 2004, 3: 279-283.PubMed

Hanazaki K, Kajikawa S, Shimozawa N, et al: Prognostic factors of intrahepatic cholangiocarcinoma after hepatic resection: univariate and multivariate analysis. Hepatogastroenterology. 2002, 49: 311-316.PubMed

Lee MA, Woo IS, Kang JH, et al: Epirubicin, cisplatin, and protracted infusion of 5-Fu (ECF) in advanced intrahepatic cholangiocarcinoma. J Cancer Res Clin Oncol. 2004, 130: 346-350. 10.1007/s00432-003-0534-7.CrossRefPubMed

10.

Park J, Kim MH, Kim KP, et al: Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study. Gut Liver. 2009, 3 (4): 298-305. 10.5009/gnl.2009.3.4.298.CrossRefPubMedPubMedCentral

11.

Malhi H, Gores GJ: Cholangiocarcinoma: modern advances in understanding a deadly old disease. J Hepatol. 2006, 45: 856-867. 10.1016/j.jhep.2006.09.001.CrossRefPubMedPubMedCentral

12.

Edge SB: American Joint Committee on Cancer: AJCC cancer staging manual. 2009, New York: Springer, 7

13.

Kawarada Y, Mizumoto R: Diagnosis and treatment of cholangiocellular carcinoma of the liver. Hepatogastroenterology. 1990, 37 (2): 176-81.PubMed

14.

Zeng ZC, Tang ZY, Fan J, et al: Consideration of the role of radiotherapy for unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 75 patients. Cancer J. 2006, 14: 113-122.

15.

Trotti A, Byhardt R, Stetz J, et al: Common toxicity criteria: version 2.0: An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys. 2000, 47: 13-47. 10.1016/S0360-3016(99)00559-3.CrossRefPubMed

16.

Mosconi S, Beretta GD, Labianca R, Zampino MG, Gatta G, Heinemann V: Cholangiocarcinoma. Crit Rev Oncol Hematol. 2009, 69: 259-270. 10.1016/j.critrevonc.2008.09.008.CrossRefPubMed

17.

Crane CH, Macdonald KO, Vauthey JN, et al: Limitations of conventional doses of chemoradiation for unresectable biliary cancer. Int J Radiat Oncol Biol Phys. 2002, 53: 969-974. 10.1016/S0360-3016(02)02845-6.CrossRefPubMed

18.

Serafini FM, Sachs D, Bloomston M, et al: Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy. Am Surg. 2001, 67: 839-844.PubMed

19.

Glimelius B, Hoffman K, Sjödén PO, et al: Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996, 7: 593-600.CrossRefPubMed

20.

Hezel AF, Zhu AX: Systemic therapy for biliary tract cancers. Oncologist. 2008, 13: 415-423. 10.1634/theoncologist.2007-0252.CrossRefPubMed

21.

Valle JW, Wasan H, Johnson P, et al: Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase II study -The UK ABC-01 Study. Br J Cancer. 2009, 101 (4): 621-627. 10.1038/sj.bjc.6605211.CrossRefPubMedPubMedCentral

22.

Valle JW, Wasan HS, Palmer DD, et al: Gemcitabine with or without cisplatin in patients with advanced or metastatic biliary tract cancer: Results of a multicenter, randomized phase III trial (the UK ABC-02 trial). J Clin Oncol (Meeting Abstracts). 2009, 27 (15S): 4503-

23.

Malka D, Trarbach T, Fartoux L, et al: A multicenter, randomized phase II trial of gemcitabine and oxaliplatin alone or in combination with biweekly cetuximab in the first-line treatment of advanced biliary cancer: Interim analysis of the BINGO trial. J Clin Oncol (Meeting Abstracts). 2009, 27 (15S): 4520-

24.

Herber S, Otto G, Schneider J, et al: Transarterial chemoembolization (TACE) for inoperable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol. 2007, 30: 1156-65. 10.1007/s00270-007-9032-7.CrossRefPubMed

25.

Kim JM, Yoon HK, Sung KB, et al: Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma: clinical efficacy and factors influencing outcomes. Cancer. 2008, 113: 1614-22. 10.1002/cncr.23787.CrossRefPubMed

26.

Zeng ZC, Tang ZY, Fan J, et al: A comparison of chemoembolization combination with and without radiotherapy for unresectable hepatocellular carcinoma. Cancer J. 2004, 10: 307-316. 10.1097/00130404-200409000-00008.CrossRefPubMed

27.

Zeng ZC, Tang ZY, Fan J, et al: Consideration of the role of radiotherapy for lymph node metastases in patients with HCC, retrospective analysis for prognostic factors from 125 patients. Int J Radiation Oncology Biol Phys. 2005, 63: 1067-1076. 10.1016/j.ijrobp.2005.03.058.CrossRef

28.

Liang SX, Jiang GL, Zhu XD, et al: Prognostic factor of primary liver cancer treated by hypofractionated three-dimensional conformal radiotherapy. Zhonghua Zhong Liu Za Zhi. 2005, 27 (10): 613-5.PubMed

29.

Mendez Romero A, Wunderink W, Hussain SM, et al: Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase I-II study. Acta Oncol. 2006, 45: 831-837. 10.1080/02841860600897934.CrossRefPubMed

30.

Tse RV, Hawkins M, Lockwood G, et al: Phase I Study of Individualized Stereotactic Body Radiotherapy for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. J Clin Oncol. 2008, 26 (4): 657-64. 10.1200/JCO.2007.14.3529.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/10/492/prepub

Title: Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients
Authors: Yi-Xing Chen
Zhao-Chong Zeng
Zhao-You Tang
Jia Fan
Jian Zhou
Wei Jiang
Meng-Su Zeng
Yun-Shan Tan
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2010
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/1471-2407-10-492

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

Troglitazone suppresses telomerase activity independently of PPARγ in estrogen-receptor negative breast cancer cells

Mass spectrometry protein expression profiles in colorectal cancer tissue associated with clinico-pathological features of disease

Differential expression of centrosomal proteins at different stages of human glioma

A genomic and transcriptomic approach for a differential diagnosis between primary and secondary ovarian carcinomas in patients with a previous history of breast cancer

Cardiotoxicity of anthracycline agents for the treatment of cancer: Systematic review and meta-analysis of randomised controlled trials

Pharmacokinetic properties and antitumor efficacy of the 5-fluorouracil loaded PEG-hydrogel

Keynote webinar | Spotlight on antibody–drug conjugates in cancer