title: Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  Optimal therapy for patients with unresectable locally advanced extrahepatic cholangiocarcinoma (ULAC) remains controversial. We analysed the role of radiotherapy in the management of such tumors.
  
  
  METHODS
  We retrospectively reviewed the charts of patients treated in our institution with conformal-3D external-beam-radiotherapy (EBRT) with or without concurrent chemotherapy.
  
  
  RESULTS
  Thirty patients were included: 24 with a primary tumor (group 1) and 6 with a local relapse (group 2). Toxicity was low. Among 25 patients assessable for EBRT response, we observed 9 complete responses, 4 partial responses, 10 stabilisations, and 2 progressions. The median follow-up was 12 months. Twenty out of 30 patients (66%) experienced a relapse, which was metastatic in 75% of cases in the whole series, 87% in group 1, 60% in group 2 (p = 0.25). Twenty-eight patients (93%) died of relapse or disease complications. Median overall survivals in the whole group and in group 1 or 2 were respectively 12, 11 and 21 months (p = 0.11). The 1-year and 3-year progression-free survivals were respectively 38% and 16% in the whole series; 31% and 11% in group 1, 67% and 33% in group 2 (p = 0.35).
  
  
  CONCLUSIONS
  EBRT seems efficient to treat ULAC, with acceptable toxicity. For primary disease, the high rate of metastatic relapse suggests to limit EBRT to non-progressive patients after induction chemotherapy.
authors.affiliation: Department of Radiation Therapy, Institut Paoli-Calmettes, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France. moureaul@ipc.unicancer.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Moureau-Zabotto
authors.forename: Olivier
authors.initials: O
authors.lastname: Turrini
authors.forename: Michel
authors.initials: M
authors.lastname: Resbeut
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Raoul
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.forename: Flora
authors.initials: F
authors.lastname: Poizat
authors.forename: Gilles
authors.initials: G
authors.lastname: Piana
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
authors.forename: Francois
authors.initials: F
authors.lastname: Bertucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019468:Disease Management; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden