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Actual over 3-year survival after stereotactic body radiation therapy in patients with unresectable intrahepatic cholangiocarcinoma

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Abstract

Purpose

As a non-invasive treatment, stereotactic body radiation therapy (SBRT) has been an emerging and effective option for patients with unresectable intrahepatic cholangiocarcinoma (ICC). The Cyber Knife has an SBRT system, which can realize real-time tracking of tumors during treatment. It can protect the surrounding normal liver tissue while the tumor gets the therapeutic dose. The purpose of this study was to evaluate the factors affecting the local control rate for patients after SBRT treatment, and to predict the factors affecting survival rates, then to report the 3-year actual survival rates after treatment and identify the influencing factors of 3-year survival rate.

Materials and Methods

We conducted a long-term follow-up of 43 patients with unresectable intrahepatic cholangiocarcinoma who underwent Cyber Knife in our hospital from January 2016 to December 2018. Regular medical check-ups were performed every 2–3 months after SBRT to evaluated the effect of treatment.

Results

The median follow-up time was 15 months (4-78 months), and the median progression-free survival (PFS) was 6 months (95% CI, 2.788–9.212) and the median overall survival (OS) was 12 months (95% CI, 3.434–20.566), respectively. Based on modified Response Evaluation and Criteria in Solid Tumor (mRECIST), response rate (RR) and disease control rate (DCR) of SBRT in unresectable ICC were 55.2% and 86%. The 1-, 2- and 3-years OS rate were 51.2%, 32.6% and 23.3%. Multivariate analysis based on competing risk survival analysis identified that patients with multiple nodules, large diameter, high level of CA199 and CEA, poor ECOG performance status had worse overall survival (p < 0.05). Patients who survived ≥3 years had significantly lower levels of CEA, CA199, smaller tumor diameters and lower number of lesions (p < 0.05).

Conclusion

The SBRT might be a candidate option for patients who unable to perform surgery. The rate of 3-year survival after SBRT for unresectable ICC can be expected with 23.3%.

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References

  1. Dodson RM, Weiss MJ, Cosgrove D, Herman JM, Kamel I, Anders R, et al. Intrahepatic cholangiocarcinoma: management options and emerging therapies. J Am Coll Surg. 2013;217(4):736-750.e4.

    Article  PubMed  Google Scholar 

  2. Lo EC, Rucker A, Federle MP. Hepatocellular carcinoma and intrahepatic cholangiocarcinoma: imaging for diagnosis, tumor response to treatment and liver response to radiation. Semin Radiat Oncol. 2018;28(4):267–76.

    Article  PubMed  Google Scholar 

  3. De Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM. Biliary tract cancers. N Engl J Med. 1999;341(18):1368–78.

    Article  PubMed  Google Scholar 

  4. Patel T. Cholangiocarcinoma–controversies and challenges. Nat Rev Gastroenterol Hepatol. 2011;8(4):189–200.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lee AJ, Chun YS. Intrahepatic cholangiocarcinoma: the AJCC/UICC 8th edition updates. Chin Clin Oncol. 2018;7(5):52.

    Article  PubMed  Google Scholar 

  6. Morise Z, Sugioka A, Tokoro T, Tanahashi Y, Okabe Y, Kagawa T, et al. Surgery and chemotherapy for intrahepatic cholangiocarcinoma. World J Hepatol. 2010;2(2):58–64.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mosconi C, Solaini L, Vara G, Brandi N, Cappelli A, Modestino F, et al. Transarterial chemoembolization and radioembolization for unresectable intrahepatic cholangiocarcinoma-a systemic review and meta-analysis. Cardiovasc Intervent Radiol. 2021;44(5):728–38.

    Article  PubMed  Google Scholar 

  8. Chen YX, Zeng ZC, Tang ZY, Fan J, Zhou J, Jiang W, et al. Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients. BMC Cancer. 2010;10:492.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brandi G, Rizzo A, Dall’Olio FG, Felicani C, Ercolani G, Cescon M, et al. Percutaneous radiofrequency ablation in intrahepatic cholangiocarcinoma: a retrospective single-center experience. Int J Hyperthermia. 2020;37(1):479–85.

    Article  PubMed  Google Scholar 

  10. Hezel AF, Zhu AX. Systemic therapy for biliary tract cancers. Oncologist. 2008;13(4):415–23.

    Article  CAS  PubMed  Google Scholar 

  11. Shen ZT, Zhou H, Li AM, Li B, Shen JS, Zhu XX. Clinical outcomes and prognostic factors of stereotactic body radiation therapy for intrahepatic cholangiocarcinoma. Oncotarget. 2017;8(55):93541–50.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Endo I, Gonen M, Yopp AC, Dalal KM, Zhou Q, Klimstra D, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248(1):84–96.

    Article  PubMed  Google Scholar 

  13. Hyder O, Hatzaras I, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, et al. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153(6):811–8.

    Article  PubMed  Google Scholar 

  14. Shampain KL, Hackett CE, Towfighi S, Aslam A, Masch WR, Harris AC, et al. SBRT for HCC: overview of technique and treatment response assessment. Abdom Radiol (NY). 2021;46(8):3615–24.

    Article  PubMed  Google Scholar 

  15. Huertas A, Baumann AS, Saunier-Kubs F, Salleron J, Oldrini G, Croisé-Laurent V, et al. Stereotactic body radiation therapy as an ablative treatment for inoperable hepatocellular carcinoma. Radiother Oncol. 2015;115(2):211–6.

    Article  PubMed  Google Scholar 

  16. Rusthoven KE, Hasselle MD. SBRT for unresectable HCC: a familiar tune? J Surg Oncol. 2010;102(3):207–8.

    Article  PubMed  Google Scholar 

  17. Kim JH, Yoon HK, Sung KB, Ko GY, Gwon DI, Shin JH, et al. Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma: clinical efficacy and factors influencing outcomes. Cancer. 2008;113(7):1614–22.

    Article  PubMed  Google Scholar 

  18. Fu Y, Yang W, Wu W, Yan K, Xing BC, Chen MH. Radiofrequency ablation in the management of unresectable intrahepatic cholangiocarcinoma. J Vasc Interv Radiol. 2012;23(5):642–9.

    Article  PubMed  Google Scholar 

  19. Zheng X, Chen B, Wu JX, Jia AY, Rong WQ, Wang LM, et al. Benefit of adjuvant radiotherapy following narrow-margin hepatectomy in patients with intrahepatic cholangiocarcinoma that adhere to major vessels. Cancer Manag Res. 2018;10:3973–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sahai P, Kumar S. External radiotherapy and brachytherapy in the management of extrahepatic and intrahepatic cholangiocarcinoma: available evidence. Br J Radiol. 2017;90(1076):20170061.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sugiyama K, Kamiyama T, Ohmura T, Nagatsu A, Shimada S, Einama T, et al. A case of locally advanced intrahepatic cholangiocarcinoma successfully treated by conversion surgery after hepatic arterial infusion chemotherapy and radiation therapy. Gan To Kagaku Ryoho. 2018;45(4):664–6.

    PubMed  Google Scholar 

  22. Sebastian NT, Tan Y, Miller ED, Williams TM, Alexandra Diaz D. Stereotactic body radiation therapy is associated with improved overall survival compared to chemoradiation or radioembolization in the treatment of unresectable intrahepatic cholangiocarcinoma. Clin Transl Radiat Oncol. 2019;19:66–71.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Barney BM, Olivier KR, Miller RC, Haddock MG. Clinical outcomes and toxicity using stereotactic body radiotherapy (SBRT) for advanced cholangiocarcinoma. Radiat Oncol. 2012;7:67.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81.

    Article  CAS  PubMed  Google Scholar 

  25. Morizane C, Okusaka T, Mizusawa J, Katayama H, Ueno M, Ikeda M, et al. Combination gemcitabine plus S-1 versus gemcitabine plus cisplatin for advanced/recurrent biliary tract cancer: the FUGA-BT (JCOG1113) randomized phase III clinical trial. Ann Oncol. 2019;30(12):1950–8.

    Article  CAS  PubMed  Google Scholar 

  26. EASL-EORTC Clinical Practice Guidelines. Management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.

    Article  Google Scholar 

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Author notes

  1. Xiao-xue Zhang, Hong-bin Ma and Tie-hua Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China

    Xiao-xue Zhang, Hong-bin Ma, Tie-hua Li & Yan Meng

  2. Department of Radiology, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China

    Bin Huang & Ning-yang Jia

  3. Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

    Xiao-xue Zhang

Authors
  1. Xiao-xue Zhang
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  4. Bin Huang
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Contributions

YM and N-YJ had full access to all the data in the study and are responsible for the integrity of the data and the accuracy of the data analyses. Study concept and design, and drafting of the manuscript: X-XZ, H-BM, T-HL, BH; collection and assembly of data: X-XZ, H-BM, T-HL, BH; data collecting, analysis and interpretation: X-XZ, H-BM, T-HL, BH; revised the article critically for important intellectual content, and administrative support: YM, N-YJ, X-XZ, H-BM, T-HL, BH. All authors have read, edited and approved of the final version of the manuscript.

Corresponding authors

Correspondence to Ning-yang Jia or Yan Meng.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Zhang, Xx., Ma, Hb., Li, Th. et al. Actual over 3-year survival after stereotactic body radiation therapy in patients with unresectable intrahepatic cholangiocarcinoma. Clin Transl Oncol 25, 731–738 (2023). https://doi.org/10.1007/s12094-022-02979-5

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