title: Intensity-modulated radiotherapy following null-margin resection is associated with improved survival in the treatment of intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  The current study is the first to examine the effectiveness and toxicity of postoperative intensity-modulated radiotherapy (IMRT) in the treatment of intrahepatic cholangiocarcinoma (ICC) abutting the vasculature. Specifically, we aim to assess the role of IMRT in patients with ICC undergoing null-margin (no real resection margin) resection.
  
  
  METHODS
  Thirty-eight patients with ICC adherent to major blood vessels were included in this retrospective study. Null-margin resection was performed on all patients; 14 patients were further treated with IMRT. The median radiation dose delivered was 56.8 Gy (range, 50-60 Gy). The primary endpoints were overall survival (OS) and disease-free survival (DFS).
  
  
  RESULTS
  At a median follow-up of 24.6 months, the median OS and DFS of all patients (n=38) were 17.7 months (95% CI, 13.2-22.2) and 9.9 months (95% CI, 2.8-17.0), respectively. Median OS was 21.8 months (95% CI, 15.5-28.1) among the 14 patients in the postoperative IMRT group and 15.0 months (95% CI, 9.2-20.9) among the 24 patients in the surgery-only group (P=0.049). Median DFS was 12.5 months (95% CI, 6.8-18.2) in the postoperative IMRT group and 5.5 months (95% CI, 0.7-12.3) in the surgery-only group (P=0.081). IMRT was well-tolerated. Acute toxicity included one case of Grade 3 leukopenia; late toxicity included one case of asymptomatic duodenal ulcer discovered through endoscopy.
  
  
  CONCLUSIONS
  The study results suggest that postoperative IMRT is a safe and effective treatment option following null-margin resections of ICC. Larger prospective and randomized trials are necessary to establish postoperative IMRT as a standard practice for the treatment of ICC adherent to major hepatic vessels.
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Angela Y
authors.initials: AY
authors.lastname: Jia
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Jian-Xiong
authors.initials: JX
authors.lastname: Wu
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Zhao
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Ye-Xiong
authors.initials: YX
authors.lastname: Li
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Wei-Qi
authors.initials: WQ
authors.lastname: Rong
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Wang
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Jin
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Shu-Lian
authors.initials: SL
authors.lastname: Wang
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Yong-Wen
authors.initials: YW
authors.lastname: Song
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Yue-Ping
authors.initials: YP
authors.lastname: Liu
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Ren
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Fang
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Wen-Qing
authors.initials: WQ
authors.lastname: Wang
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Xin-Fan
authors.initials: XF
authors.lastname: Liu
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Zi-Hao
authors.initials: ZH
authors.lastname: Yu
authors.affiliation: 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China.
authors.forename: Wei-Hu
authors.initials: WH
authors.lastname: Wang
keywords: Radiotherapy; intensity-modulated; intrahepatic cholangiocarcinoma (ICC); null-margin resection; postoperative radiotherapy
references.citation: Ann Surg. 2011 Apr;253(4):656-65
references.pmid: 21475004
references.citation: J Gastrointest Surg. 2014 Mar;18(3):562-72
references.pmid: 24395070
references.citation: Ann Surg. 1996 Oct;224(4):463-73; discussion 473-5
references.pmid: 8857851
references.citation: Arch Surg. 2007 Jul;142(7):596-602; discussion 603
references.pmid: 17638795
references.citation: World J Surg. 2014 Jul;38(7):1777-85
references.pmid: 24370545
references.citation: Semin Liver Dis. 1994 May;14(2):109-14
references.pmid: 8047893
references.citation: Ann Surg. 2005 Jan;241(1):134-43
references.pmid: 15622001
references.citation: Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):178-82
references.pmid: 17276614
references.citation: Int J Radiat Oncol Biol Phys. 2008 Dec 1;72(5):1495-501
references.pmid: 18472359
references.citation: Semin Liver Dis. 2013 Aug;33(3):248-61
references.pmid: 23943105
references.citation: Surgery. 1989 Oct;106(4):740-8; discussion 748-9
references.pmid: 2799650
references.citation: Am Surg. 2001 Sep;67(9):839-43; discussion 843-4
references.pmid: 11565760
references.citation: Hepatogastroenterology. 2011 Mar-Apr;58(106):575-82
references.pmid: 21661434
references.citation: Hepatogastroenterology. 1990 Apr;37(2):172-5
references.pmid: 1692802
references.citation: Ann Surg. 2011 Nov;254(5):824-29; discussion 830
references.pmid: 22042474
references.citation: Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):148-53
references.pmid: 18805651
references.citation: J Hepatol. 2004 Mar;40(3):472-7
references.pmid: 15123362
references.citation: Ann Surg Oncol. 2008 Feb;15(2):600-8
references.pmid: 17987347
references.citation: Ann Surg. 2008 Jul;248(1):84-96
references.pmid: 18580211
references.citation: Oncogene. 2013 Oct 10;32(41):4861-70
references.pmid: 23318457
references.citation: Semin Liver Dis. 2004 May;24(2):115-25
references.pmid: 15192785
references.citation: Ann Surg Oncol. 2008 Nov;15(11):3147-56
references.pmid: 18754070
references.citation: Semin Liver Dis. 2011 Feb;31(1):49-60
references.pmid: 21344350
references.citation: AJR Am J Roentgenol. 2011 Feb;196 (2):W205-9
references.pmid: 21257864