Zahra Ghiassi-Nejad1, Paola Tarchi2, Erin Moshier3, Meng Ru3, Parissa Tabrizian4, Myron Schwartz4, Michael Buckstein5. 1. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Department of General Surgery, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy. 3. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Michael.Buckstein@mountsinai.org.
Abstract
PURPOSE: To identify prognostic factors and patterns of local failure in patients with cholangiocarcinoma (CCA), after surgical resection in the absence of adjuvant radiation, for optimal definition of target volumes encompassing the majority of local recurrences. METHODS AND MATERIALS: A chart review was performed in patients who underwent resection for primary CCA (intrahepatic, hilar, and distal) between 1999 and 2014. Local failure was defined as recurrence in a theoretical reasonable postoperative radiation volume. This includes the cut surface of liver, biliary anastomosis, hilum, portal nodes, celiac nodes, peri-pancreatic nodes, gastro-hepatic nodes, and retroperitoneal nodes. Patients who received adjuvant radiation were excluded. RESULTS: A total of 189 patients underwent surgical resection for CCA, of whom 145 patients had sufficient follow-up. Median follow-up was 41.6 months (95% confidence interval 35.4-48.7 months). Of the 145 cases, 102 were intrahepatic and 43 were hilar/distal CCA. Adjuvant chemotherapy was given in 38 cases (26%), of which 20 (54%) were gemcitabine-based. Eighty-six patients (59%) had a documented recurrence, of whom 44 (51%) had a locoregional component. Among patients who had a recurrence, 23 (27%) had a recurrence at the biliary anastomosis and/or cut liver surface. Twenty-eight patients (32.6%) had a recurrence in the regional lymph nodes, most prevalent in the portal (16.3%) and retroperitoneal (17.4%) lymph nodes. Univariable analysis identified tumor size, any vascular invasion, presence of satellites, stage/nodal status, and receipt of chemotherapy as significant prognostic factors of overall recurrence among intrahepatic patients. Presence of satellites, and stage 3/Nx status remained statistically significant in multivariable modeling. CONCLUSIONS: The areas at highest risk for locoregional recurrence after surgical resection for primary CCA are the biliary anastomosis/cut liver surface, portal lymph nodes, and retroperitoneal lymph nodes. Although these results need to be validated, adjuvant radiation should possibly cover these areas to maximize locoregional control.
PURPOSE: To identify prognostic factors and patterns of local failure in patients with cholangiocarcinoma (CCA), after surgical resection in the absence of adjuvant radiation, for optimal definition of target volumes encompassing the majority of local recurrences. METHODS AND MATERIALS: A chart review was performed in patients who underwent resection for primary CCA (intrahepatic, hilar, and distal) between 1999 and 2014. Local failure was defined as recurrence in a theoretical reasonable postoperative radiation volume. This includes the cut surface of liver, biliary anastomosis, hilum, portal nodes, celiac nodes, peri-pancreatic nodes, gastro-hepatic nodes, and retroperitoneal nodes. Patients who received adjuvant radiation were excluded. RESULTS: A total of 189 patients underwent surgical resection for CCA, of whom 145 patients had sufficient follow-up. Median follow-up was 41.6 months (95% confidence interval 35.4-48.7 months). Of the 145 cases, 102 were intrahepatic and 43 were hilar/distal CCA. Adjuvant chemotherapy was given in 38 cases (26%), of which 20 (54%) were gemcitabine-based. Eighty-six patients (59%) had a documented recurrence, of whom 44 (51%) had a locoregional component. Among patients who had a recurrence, 23 (27%) had a recurrence at the biliary anastomosis and/or cut liver surface. Twenty-eight patients (32.6%) had a recurrence in the regional lymph nodes, most prevalent in the portal (16.3%) and retroperitoneal (17.4%) lymph nodes. Univariable analysis identified tumor size, any vascular invasion, presence of satellites, stage/nodal status, and receipt of chemotherapy as significant prognostic factors of overall recurrence among intrahepaticpatients. Presence of satellites, and stage 3/Nx status remained statistically significant in multivariable modeling. CONCLUSIONS: The areas at highest risk for locoregional recurrence after surgical resection for primary CCA are the biliary anastomosis/cut liver surface, portal lymph nodes, and retroperitoneal lymph nodes. Although these results need to be validated, adjuvant radiation should possibly cover these areas to maximize locoregional control.
Authors: Seo Hee Choi; Chai Hong Rim; In-Soo Shin; Won Sup Yoon; Woong Sub Koom; Jinsil Seong Journal: Liver Cancer Date: 2021-08-26 Impact factor: 11.740
Authors: Edward Christopher Dee; Morgan E Freret; Nora Horick; Ann C Raldow; Lipika Goyal; Andrew X Zhu; Aparna R Parikh; David P Ryan; Jeffrey W Clark; Jill N Allen; Cristina R Ferrone; Carlos Fernandez-Del Castillo; Kenneth K Tanabe; Lorraine C Drapek; Theodore S Hong; Motaz Qadan; Jennifer Y Wo Journal: Ann Surg Oncol Date: 2020-08-01 Impact factor: 5.344
Authors: Hoon Sik Choi; Ki Mun Kang; Bae Kwon Jeong; Hojin Jeong; Yun Hee Lee; In Bong Ha; Tae Gyu Kim; Jin Ho Song Journal: Radiat Oncol Date: 2018-05-08 Impact factor: 3.481