Chemoradiation may prolong survival of patients with non-bulky unresectable extrahepatic biliary carcinoma. A retrospective analysis.
OBJECTIVE
. This study compared stenting and chemoradiation (CRT) and attempted to identify factors that are predictive of response to CRT.


METHODS
. A retrospective analysis identified 98 patients treated. The primary tumor and lymphatics received 45 Gy of three-dimensional conformal radiotherapy. Tumors were boosted to a median total dose of 50.8 Gy. Simultaneous chemotherapy was 5-fluorouracil- (5-FU) and gemcitabine-based. RTOG/NCI-CTC toxicity criteria were applied.


RESULTS
. Median survival time was 11.8 months for all patients, 9.3 months for patients with stenting alone and 16.5 months with CRT (p = 0.22). Only tumor diameter was predictive of survival for treatment with CRT. A threshold of 40 mm at diagnosis distinguished two survival profiles (21.4 vs. 8.7 months; p = 0.01). Toxicity was lower for 5-FU-based CRT compared to gemcitabinebased CRT, but a safe schedule for gemcitabine-based CRT was identified. Two patients (2/25) with unresectable tumors at diagnosis had pathohistological complete response at resection after CRT.


CONCLUSIONS
. Inclusion criteria for future CRT trials should be based on tumor size at diagnosis: patients otherwise eligible for CRT should only be included with an inoperable tumor </= 40 mm, while patients with larger tumors may only benefit from palliation by stenting.
Brunner
Thomas B
TB
Department of Radiation Oncology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany, tb@strahlen.med.uni-erlangen.de.
Schwab
Dieter
D
Meyer
Thomas
T
Sauer
Rolf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic / Q000187:drug effects* / Q000528:radiation effects*; D003131:Combined Modality Therapy / Q000401:mortality; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine