title: Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  Extrahepatic cholangiocarcinoma is an uncommon but lethal malignancy. We analyzed the role of definitive chemoradiotherapy for patients with nonmetastatic, locally advanced extrahepatic cholangiocarcinoma treated at a single institution.
  
  
  METHODS
  This retrospective analysis included 37 patients who underwent external beam radiation therapy (EBRT) with concurrent chemotherapy and/or brachytherapy (BT) for locally advanced extrahepatic cholangiocarcinoma. Local control (LC) and overall survival (OS) were assessed, and univariate regression analysis was used to evaluate the effects of patient- and treatment-related factors on clinical outcomes.
  
  
  RESULTS
  Twenty-three patients received EBRT alone, 8 patients received EBRT plus BT, and 6 patients received BT alone (median follow-up of 14 months). Two patients were alive without evidence of recurrence at the time of analysis. Actuarial OS and LC rates at 1 year were 59% and 90%, respectively, and 22% and 71%, respectively, at 2 years. Two patients lived beyond 5 years without evidence of recurrence. On univariate analysis, EBRT with or without BT improved LC compared to BT alone (97% vs. 56% at 1 year; 75% vs. 56% at 2 years; p = 0.096). Patients who received EBRT alone vs. BT alone also had improved LC (96% vs. 56% at 1 year; 80% vs. 56% at 2 years; p = 0.113). Age, gender, tumor location (proximal vs. distal), histologic differentiation, EBRT dose (≤ or >50 Gy), EBRT planning method (two-dimensional vs. three-dimensional), and chemotherapy were not associated with patient outcomes.
  
  
  CONCLUSIONS
  Patients with locally advanced extrahepatic cholangiocarcinoma have poor survival. Long-term survival is rare. The majority of patients treated with EBRT had local control at the time of death, suggesting that symptoms due to the local tumor effect might be effectively controlled with radiation therapy, and EBRT is an important element of treatment. Novel treatment approaches are indicated in the therapy for this disease.
authors.affiliation: Department of Radiation Oncology, Division of Medical Oncology and Transplantation, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: A Paiman
authors.initials: AP
authors.lastname: Ghafoori
authors.forename: John W
authors.initials: JW
authors.lastname: Nelson
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Willett
authors.forename: Junzo
authors.initials: J
authors.lastname: Chino
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Herbert I
authors.initials: HI
authors.lastname: Hurwitz
authors.forename: Hope E
authors.initials: HE
authors.lastname: Uronis
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morse
authors.forename: Robert W
authors.initials: RW
authors.lastname: Clough
authors.forename: Brian G
authors.initials: BG
authors.lastname: Czito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic; D001918:Brachytherapy / Q000379:methods; D059248:Chemoradiotherapy / Q000379:methods*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies