Stereotactic body radiotherapy dose and its impact on local control and overall survival of patients for locally advanced intrahepatic and extrahepatic cholangiocarcinoma. (March 2019)

• Record Type: Journal Article
• Authors: Brunner, Thomas B.; Blanck, Oliver; Lewitzki, Victor; Abbasi-Senger, Nasrin; Momm, Felix; Riesterer, Oliver; Duma, Marciana Nona; Wachter, Stefan; Baus, Wolfgang; Gerum, Sabine; Guckenberger, Matthias; Gkika, Eleni
• Is Part Of: Radiotherapy and oncology. Volume 132(2019)
• Page Start: 42
• Page End: 47
• Publication Date: 2019-03
• Subjects: Cholangiocarcinoma -- Stereotactic body radiotherapy -- Unresectable; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2018.11.015
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: This is the largest series of stereotactic body radiotherapy for cholangiocarcinoma. Patients who were treated with a higher maximum dose had longer overall survival compared to patients treated with lower dose. SBRT prescribed dose, median dose to the GTV and maximum dose all predicted local control. SBRT was well tolerated with few side effects. Abstract: Purpose: Non-resectable cholangiocarcinoma (CCC) is a significant therapeutic challenge because of bad prognosis. This study analyzed the outcome after SBRT for intra- and extrahepatic CCC. Material and methods: Sixty-four patients with 82 CCC lesions from a retrospective multicenter database were analyzed. Available parameters were analyzed for local control (LC), overall survival (OS) and toxicity. Results: Median follow-up time for patients alive was 35 months (range 7–91 months). Median overall survival (OS) time was 15 months; 2-year and 3-year OS rates were 32% and 21%. Median prescribed biological effective radiation dose (BED, α/β = 10) was 67.2 Gy10 (range, 36–115 Gy10 ; SD: 20 Gy10 ) in median 8 fractions (range, 3–17; 95% CI: 3–12), median BEDmax was 91 Gy10 . BED was the only prognostic factor for LC and OS. Patients receiving BEDmax >91 Gy10 had a median OS of 24 months vs. 13 months for those receiving lower doses ( p = 0.008). LC rates at 12 and 24 months were 91% and 80% for BEDmax >91 Gy10 vs. 66% and 39% for lower doses ( p = 0.009). Of note, tumor size and PTV were neither predictive nor prognostic for LC and OS. Treatment tolerance was good with 17% of grade 1 gastroduodenitis, 11% of grade 2–3 cholangitis and 4.7% of grade 3 gastrointestinal bleeding. Conclusion: This is the largest reported series on SBRT in cholangiocarcinoma. Overall survival and local control were significantly improved after higher doses (BED) and tolerance was excellent.