Outcomes from combined chemoradiotherapy in unresectable and locally advanced resected cholangiocarcinoma.
OBJECTIVE
Whilst surgery is the only potentially curative treatment for cholangiocarcinoma, many patients are either unfit for major surgery or have unresectable disease. Patients who undergo attempted curative resective surgery often have involved resection margins. The role of radiotherapy in these settings has not been clarified and is often not considered because of fears of late complications, especially liver and gastrointestinal toxicity. We present our experience of treating cholangiocarcinoma, either unresectable or locally advanced, with conformal radiotherapy and concurrent chemotherapy, examining survival, toxicity, patterns of failure and details of radiotherapy and chemotherapy administered.


METHODS
Between 1995 and 2005, 20 patients, median age 60.5 years (range 45-78 years) with cholangiocarcinoma received radical conformal radiotherapy (median dose 46 Gy in 1.8-2.0 Gy fractions) with concurrent cisplatin/5-FU and sequential gemcitabine chemotherapy.


RESULTS
Overall median survival was 20.4 months, 2 year survival, 43% and relapse-free survival, 9.6 months. 19/20 patients (95%) have died. One patient remains alive with liver and bone metastases. First site of failure was local and within radiotherapy field in 9/20 (45%) patients. No patient required interruption of radiotherapy for radiation toxicity, and none experienced subsequent late liver toxicity.


CONCLUSIONS
The survival of this group of historically poor prognosis patients is encouraging. Durable local control was achieved in a majority of patients having chemoradiotherapy and toxicity was not severe. Although most patients still succumbed to disease, treatment delayed onset of progression. Conformal radiotherapy should be considered as an integral component in new investigative approaches to treatment in this rare cancer.
Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia. eleong@aanet.com.au
Eugene
E
Leong
Wei Wen
WW
Chen
Evan
E
Ng
Guy
G
Van Hazel
Andrew
A
Mitchell
Nigel
N
Spry
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D059248:Chemoradiotherapy / Q000009:adverse effects; D018281:Cholangiocarcinoma / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome