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Improved oncologic outcome with chemoradiotherapy followed by surgery in unresectable intrahepatic cholangiocarcinoma

 Yeona Cho  ;  Tae Hyung Kim  ;  Jinsil Seong 
 STRAHLENTHERAPIE UND ONKOLOGIE, Vol.193(8) : 620-629, 2017 
Journal Title
Issue Date
Adult ; Aged ; Bile Duct Neoplasms/mortality* ; Bile Duct Neoplasms/therapy* ; Chemoradiotherapy, Adjuvant/mortality* ; Cholangiocarcinoma ; Cohort Studies ; Combined Modality Therapy/mortality ; Female ; Hepatectomy/mortality* ; Hepatectomy/utilization ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/mortality* ; Neoplasm Recurrence, Local/prevention & control* ; Prevalence ; Radiotherapy Dosage ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Survival Rate
Chemotherapy ; Hepatectomy ; Liver neopla는 ; Radiotherapy ; Survival
PURPOSE: To investigate the ability of chemoradiotherapy (CRT) to down-stage unresectable intrahepatic cholangiocarcinoma (IHCC) to resectable lesions, as well as the factors associated with achieving such down-staging. METHODS: The study cohort comprised 120 patients diagnosed with stage I-IVA IHCC between 2001 and 2012. Of these patients, 56 underwent surgery and 64 received CRT as their initial treatment. The rate of curative resections for patients who received CRT was assessed, and the locoregional failure-free survival (LRFFS) and overall survival (OS) rates of these patients were compared to those of patients who underwent CRT alone. RESULTS: Median follow-up was 36 months. A partial response after CRT was observed in 25% of patients, whereas a biologic response (a >70% decrease of CA19-9) was observed in 35%. Eight patients (12.5%) received curative resection after CRT and showed significantly improved LRFFS and OS compared to those treated with CRT alone (3-year LRFFS: 50 vs. 15.7%, respectively, p = 0.03; 3‑year OS: 50 vs. 11.2%, respectively, p = 0.012); these rates were comparable to those of patients who received initial surgery. Factors associated with curative surgery after CRT were gemcitabine administration, higher radiotherapy dose (biological effective dose ≥55 Gy with α/β = 10), and a >70% reduction of CA19-9. CONCLUSION: Upfront CRT could produce favorable outcomes by converting unresectable lesions to resectable tumors in selected patients. Higher radiotherapy doses and gemcitabine-based chemotherapy yielded a significant reduction of CA19-9 after CRT; patients with these characteristics had a greater chance of curative resection and improved OS.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Cho, Yeona(조연아) ORCID logo https://orcid.org/0000-0002-1202-0880
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