Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma

A. Paiman Ghafoori, John W. Nelson, Christopher G. Willett, Junzo Chino, Douglas Tyler, Herbert I. Hurwitz, Hope E. Uronis, Michael A. Morse, Robert W. Clough, Brian G. Czito

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Purpose: 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 and Materials: 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.

Original languageEnglish (US)
Pages (from-to)654-659
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume81
Issue number3
DOIs
StatePublished - Nov 1 2011
Externally publishedYes

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Cholangiocarcinoma
radiation therapy
Radiotherapy
Brachytherapy
Therapeutics
Survival
chemotherapy
tumors
Recurrence
Drug Therapy
Neoplasms
Chemoradiotherapy
death
planning
regression analysis
therapy
Regression Analysis

Keywords

  • 5-Fluorouracil
  • Adjuvant therapy
  • Biliary cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma. / Ghafoori, A. Paiman; Nelson, John W.; Willett, Christopher G.; Chino, Junzo; Tyler, Douglas; Hurwitz, Herbert I.; Uronis, Hope E.; Morse, Michael A.; Clough, Robert W.; Czito, Brian G.

In: International Journal of Radiation Oncology Biology Physics, Vol. 81, No. 3, 01.11.2011, p. 654-659.

Research output: Contribution to journalArticle

Ghafoori, AP, Nelson, JW, Willett, CG, Chino, J, Tyler, D, Hurwitz, HI, Uronis, HE, Morse, MA, Clough, RW & Czito, BG 2011, 'Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma', International Journal of Radiation Oncology Biology Physics, vol. 81, no. 3, pp. 654-659. https://doi.org/10.1016/j.ijrobp.2010.06.018
Ghafoori, A. Paiman ; Nelson, John W. ; Willett, Christopher G. ; Chino, Junzo ; Tyler, Douglas ; Hurwitz, Herbert I. ; Uronis, Hope E. ; Morse, Michael A. ; Clough, Robert W. ; Czito, Brian G. / Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 81, No. 3. pp. 654-659.
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abstract = "Purpose: 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 and Materials: 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.",
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AU - Ghafoori, A. Paiman

AU - Nelson, John W.

AU - Willett, Christopher G.

AU - Chino, Junzo

AU - Tyler, Douglas

AU - Hurwitz, Herbert I.

AU - Uronis, Hope E.

AU - Morse, Michael A.

AU - Clough, Robert W.

AU - Czito, Brian G.

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N2 - Purpose: 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 and Materials: 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.

AB - Purpose: 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 and Materials: 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.

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