title: Chemoradiation in patients with unresectable extrahepatic and hilar cholangiocarcinoma or at high risk for disease recurrence after resection : Analysis of treatment efficacy and failure in patients receiving postoperative or primary chemoradiation.
abstract: BACKGROUND
  The purpose of this work was to determine efficacy, toxicity, and patterns of recurrence after concurrent chemoradiation (CRT) in patients with extrahepatic bile duct cancer (EHBDC) and hilar cholangiocarcinoma (Klatskin tumours) in case of incomplete resection or unresectable disease.
  
  
  METHODS
  From 2003-2010, 25 patients with nonmetastasized EHBDC and hilar cholangiocarcinoma were treated with radiotherapy and CRT at our institution in an postoperative setting (10 patients, 9 patients with R1 resections) or in case of unresectable disease (15 patients). Median age was 63 years (range 38-80 years) and there were 20 men and 5 women. Median applied dose was 45 Gy in both patient groups.
  
  
  RESULTS
  Patients at high risk (9 times R1 resection, 1 pathologically confirmed lymphangiosis) for tumour recurrence after curative surgery had a median time to disease progression of 8.7 months and an estimated mean overall survival of 23.2 months (6 of 10 patients are still under observation). Patients undergoing combined chemoradiation in case of unresectable primary tumours are still having a poor prognosis with a progression-free survival of 7.1 months and a median overall survival of 12.0 months. The main site of progression was systemic (liver, peritoneum) in both patient groups.
  
  
  CONCLUSIONS
  Chemoradiation with gemcitabine is safe and can be applied safely in either patients with EHBDC or Klatskin tumours at high risk for tumour recurrence after resection and patients with unresectable tumours. Escalation of systemic and local treatment should be investigated in future clinical trials.
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. daniel.habermehl@med.uni-heidelberg.de
authors.forename: D
authors.initials: D
authors.lastname: Habermehl
authors.forename: K
authors.initials: K
authors.lastname: Lindel
authors.forename: S
authors.initials: S
authors.lastname: Rieken
authors.forename: K
authors.initials: K
authors.lastname: Haase
authors.forename: B
authors.initials: B
authors.lastname: Goeppert
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: P
authors.initials: P
authors.lastname: Schirmacher
authors.forename: T
authors.initials: T
authors.lastname: Welzel
authors.forename: J
authors.initials: J
authors.lastname: Debus
authors.forename: S E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000628:therapy*; D001652:Bile Ducts / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D011182:Postoperative Care / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome