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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.

Author information

1
Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
2
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
3
Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
4
Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
5
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA. JWO@mgh.harvard.edu.
6
Clark Center for Radiation Oncology, Boston, MA, USA. JWO@mgh.harvard.edu.

Abstract

OBJECTIVE:

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).

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

PMID:
31873931
DOI:
10.1245/s10434-019-08142-9

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