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Ann Surg Oncol. 2020 Apr;27(4):1122-1129. doi: 10.1245/s10434-019-08142-9. Epub 2019 Dec 23.

Hypofractionated Radiation Therapy for Unresectable/Locally Recurrent Intrahepatic Cholangiocarcinoma.

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Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Clark Center for Radiation Oncology, Boston, MA, USA.



The aim of this study was to evaluate outcomes for patients with unresectable intrahepatic cholangiocarcinoma (ICC) treated with hypofractionated proton or photon radiation therapy (HF-RT).


We retrospectively identified 66 patients with ICC who were treated with HF-RT from 2008 to 2018. Median age at RT was 76 years (range 30-92), including 27 patients (41%) aged ≥ 80 years. Median RT dose was 58.05 Gy (range 37.5-67.5), all delivered in 15 daily fractions. Thirty-two patients received proton RT and 34 patients received photon RT.


Median follow-up times from diagnosis and RT start were 21 months and 14 months, respectively. In total, five patients (7.6%) developed local failure. The 2-year outcomes were 84% local control (LC) and 58% OS. Among the 51 patients treated with definitive intent, the 2-year LC rate was 93% and the OS rate was 62%. On multivariate analysis for LC, older age was associated with a lower risk of local failure [hazard ratio (HR) 0.91; p = 0.02], while prior surgery (HR 16.5; p = 0.04) and macrovascular invasion (HR 123.93; p = 0.02) were independently associated with an increased risk of local failure. On multivariate analysis for OS, female sex (HR 0.33; p = 0.001) and prior chemotherapy (HR 0.38; p = 0.003) remained significantly associated with OS. On multivariate analysis for OS, compared with photon RT, there was a trend towards improved survival with proton RT (HR 0.50; p = 0.05). The rate of overall grade 3 + toxicity was 11%. One patient developed radiation-induced liver disease and was treated with corticosteroids.


HF-RT yields high rates of local control and is an effective modality to optimize biliary control for unresectable/locally recurrent ICC.


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