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Radiotherapy and Chemotherapy as Therapeutic Strategies in Extrahepatic Biliary Duct Carcinoma

Radiotherapie und Chemotherapie als therapeutische Strategien bei extrahepatischen Gallenwegstumoren

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Abstract

Purpose:

This report aims to provide an overview on radiotherapy and chemotherapy in extrahepatic biliary duct carcinoma (BDC).

Patients and Methods:

A PubMed research identified clinical trials in BDC through April 1, 2010 including randomised controlled trials, SEER analyses and retrospective trials. Additionally, publications on the technical progress of radiotherapy in or close to the liver were analysed.

Results:

Most patients with cholangiocarcinoma present with unresectable disease (80–90%), and more than half of the resected patients relapse within 1 year. Adjuvant and palliative treatment options need to be chosen carefully since 50% of the patients are older than 70 years at diagnosis. Adjuvant radiotherapy or chemotherapy after complete resection (R0) has not convincingly shown a prolongation of survival but radiotherapy did after R1 resection. However, data suggest that liver transplantation could offer long-term survival in selected patients when combined with neoadjuvant chemoradiotherapy in patients with marginally resectable disease. For patients with unresectable biliary tract carcinoma (BTC), palliative stenting was previously the treatment of choice. But recent SEER analyses show that radiotherapy prolongs survival, relieves symptoms and contributes to biliary decompression and should be regarded as the new standard. Novel technical advances in radiotherapy may allow for dose-escalation and could significantly improve outcome for patients with cholangiocarcinoma.

Conclusion:

Both the literature and recent technical progress corroborate the role of radiotherapy in BDC offering chances for novel clinical trials. Progress is less pronounced in chemotherapy.

Zusammenfassung

Ziel:

Dieser Bericht gibt eine Übersicht über die Rolle der Radio- und Chemotherapie beim extrahepatischen Gallengangskarzinom (BDC).

Patienten und Methodik:

Eine PubMed-Suche identifizierte klinische Studien zum BDT bis 1. April , 2010 und schloss randomisierte kontrollierte Studien, SEER Analysen und retrospektive Studien ein. Außerdem wurden Arbeiten zum technischen Fortschritt der Radiotherapie in und nahe der Leber analysiert.

Ergebnisse:

Die Mehrzahl der Patienten mit cholangiozellulärem Karzinom befindet sich zum Zeitpunkt der Diagnose bereits in fortgeschrittenen irresektablen Tumorstadien, und auch unter den primär operablen Patienten kommt es in den meisten Fällen zum Rezidiv innerhalb eines Jahres. Adjuvante und palliative Behandlungsoptionen müssen sorgfältig gewählt werden, weil 50% der Patienten bei Daignose älter als 70 Jahre sind. Die adjuvante Radio- bzw. Chemotherapie zeigt nach R0-Resektion keinen überzeugenden Überlebensvorteil, hingegen die Radiotherapie nach R1-Resektion. Bei sorgfältig selektierten Patientengruppen gibt es Daten zum Langzeitüberleben nach neoadjuvanter Radiochemotherapie mit anschließender Lebertransplantation. In der palliativen Situation war bislang die Einlage von Endoprothesen Methode der Wahl. Jedoch zeigen neueste SEER-Analysen, dass die Radiotherapie nicht nur eine Besserung der Lebensqualität durch Besserung der Cholestase bewirkt, nsondern auch das Überleben verlängert, weshlab sie als neue Standardtherapie angesehen werden sollte. Neueste technische Entwicklungen in der Strahlentherapie eröffnen die Perspektive einer Dosiseskalation und könnten die Ergebnisse bei Patienten mit cholangiozellulären Karzinomen dramatisch verbessern.

Schlussfolgerung:

Sowohl die Literatur als auch der jüngste technische Fortschritt stärken die Rolle der Radiotherapie beim BDC und eröffnen Chancen für klinische Studien. Für die Chemotherapie ist der Fortschritt weniger ausgeprägt.

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  1. Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom

    Thomas B. Brunner & Cynthia L. Eccles

  2. Gray Institute for Radiation Oncology and Biology, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, England

    Thomas B. Brunner

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Brunner, T.B., Eccles, C.L. Radiotherapy and Chemotherapy as Therapeutic Strategies in Extrahepatic Biliary Duct Carcinoma. Strahlenther Onkol 186, 672–680 (2010). https://doi.org/10.1007/s00066-010-2161-y

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