Outcomes from Combined Chemoradiotherapy in Unresectable and Locally Advanced Resected Cholangiocarcinoma
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ORIGINAL RESEARCH
Outcomes from Combined Chemoradiotherapy in Unresectable and Locally Advanced Resected Cholangiocarcinoma Eugene Leong & Wei Wen Chen & Evan Ng & Guy Van Hazel & Andrew Mitchell & Nigel Spry
Published online: 30 October 2010 # Springer Science+Business Media, LLC 2010
Abstract Purpose Whilst surgery is the only potentially curative treatment for cholangiocarcinoma, many patients are either unfit for major surgery or have unresectable disease. Patients who undergo attempted curative resective surgery often have involved resection margins. The role of radiotherapy in these settings has not been clarified and is often not considered because of fears of late complications, especially liver and gastrointestinal toxicity. We present our experience of treating cholangiocarcinoma, either unresectable or locally advanced, with conformal radiotherapy and concurrent chemotherapy, examining survival, toxicity, patterns of failure and details of radiotherapy and chemotherapy administered. E. Leong (*) : W. W. Chen : E. Ng : N. Spry Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia e-mail: [email protected] W. W. Chen e-mail: [email protected] E. Ng e-mail: [email protected] N. Spry e-mail: [email protected] G. Van Hazel Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia e-mail: [email protected] A. Mitchell Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital, Nedlands, Australia e-mail: [email protected]
Methods Between 1995 and 2005, 20 patients, median age 60.5 years (range 45–78 years) with cholangiocarcinoma received radical conformal radiotherapy (median dose 46 Gy in 1.8–2.0 Gy fractions) with concurrent cisplatin/ 5-FU and sequential gemcitabine chemotherapy. Results Overall median survival was 20.4 months, 2 year survival, 43% and relapse-free survival, 9.6 months. 19/20 patients (95%) have died. One patient remains alive with liver and bone metastases. First site of failure was local and within radiotherapy field in 9/20 (45%) patients. No patient required interruption of radiotherapy for radiation toxicity, and none experienced subsequent late liver toxicity. Conclusions The survival of this group of historically poor prognosis patients is encouraging. Durable local control was achieved in a majority of patients having chemoradiotherapy and toxicity was not severe. Although most patients still succumbed to disease, treatment delayed onset of progression. Conformal radiotherapy should be considered as an integral component in new investigative approaches to treatment in this rare cancer. Keywords Cholangiocarcinoma . Radiation therapy . Gall bladder carcinoma
Background Cholangiocarcinomas are uncommon malignancies arising from epithelium of the bile ducts and gall bladder. Whilst rare in the United Kingdom, United States and Australia (1–2 cases per 100,000 population per year), it is more common elsewhere e.g. Japan and Israel (5–7 cases per 100,000 po
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