Rezarta Frakulli1, Milly Buwenge1, Gabriella Macchia2, Silvia Cammelli1, Francesco Deodato2, Savino Cilla3, Francesco Cellini4, Gian C Mattiucci4, Silvia Bisello1, Giovanni Brandi5, Salvatore Parisi6, Alessio G Morganti1. 1. 1 Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy. 2. 2 Radiotherapy Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart , Campobasso , Italy. 3. 3 Medical Physic Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart , Campobasso , Italy. 4. 4 Department of Radiotherapy, Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore , Rome , Italy. 5. 5 Department of Experimental, Diagnostic, and Specialty Medicine, S. Orsola-Malpighi University Hospital, Cancer Research, University of Bologna , Bologna , Italy. 6. 6 Unit of Radiotherapy, IRCCS"Casa Sollievo della Sofferenza" San Giovanni Rotondo , Italy.
Abstract
OBJECTIVE: Stereotactic body radiation therapy (SBRT) has been used in the treatment of cholangiocarcinoma (CC) but toxicity and clinical results of SBRT in CC are still limited and sparse. Therefore, the aim of this systematic review was to analyze the results of SBRT in the setting of advanced CC. METHODS: A systematic literature search was conducted on PubMed, Scopus, and Cochrane library using the PRISMA methodology. Studies including at least 10 patients with diagnosis of advanced CC regardless of tumor site and other treatments were included. The primary outcome was overall survival (OS) and secondary endpoints were local control (LC) and toxicity rates. The ROBINS-I risk of bias tool was used. RESULTS: 10 studies (231 patients) fulfilled the selection criteria and were included in this review. All but one study showed moderate to serious risk of bias. Median follow up was 15 months (range: 7.8-64.0 months). Pooled 1 year OS was 58.3% (95% CI: 50.2-66.1%) and pooled 2 year OS was 35.5% (95% CI: 22.1-50.1%). Pooled 1 year LC was 83.4%, (95% CI: 76.5-89.4%). The reported toxicities were acceptable and manageable with only one treatment-related death. CONCLUSION: The role of SBRT in CC is not yet supported by robust evidence in literature. However, within this limit, preliminary results seem almost comparable to the ones of standard chemotherapy or chemoradiation. ADVANCES IN KNOWLEDGE: SBRT seems effective in terms of LC with acceptable treatment-related toxicities. Therefore, SBRT can be considered a therapeutic option at least in selected patients with CC, possibly combined with adjuvant chemotherapy (CHT).
OBJECTIVE: Stereotactic body radiation therapy (SBRT) has been used in the treatment of cholangiocarcinoma (CC) but toxicity and clinical results of SBRT in CC are still limited and sparse. Therefore, the aim of this systematic review was to analyze the results of SBRT in the setting of advanced CC. METHODS: A systematic literature search was conducted on PubMed, Scopus, and Cochrane library using the PRISMA methodology. Studies including at least 10 patients with diagnosis of advanced CC regardless of tumor site and other treatments were included. The primary outcome was overall survival (OS) and secondary endpoints were local control (LC) and toxicity rates. The ROBINS-I risk of bias tool was used. RESULTS: 10 studies (231 patients) fulfilled the selection criteria and were included in this review. All but one study showed moderate to serious risk of bias. Median follow up was 15 months (range: 7.8-64.0 months). Pooled 1 year OS was 58.3% (95% CI: 50.2-66.1%) and pooled 2 year OS was 35.5% (95% CI: 22.1-50.1%). Pooled 1 year LC was 83.4%, (95% CI: 76.5-89.4%). The reported toxicities were acceptable and manageable with only one treatment-related death. CONCLUSION: The role of SBRT in CC is not yet supported by robust evidence in literature. However, within this limit, preliminary results seem almost comparable to the ones of standard chemotherapy or chemoradiation. ADVANCES IN KNOWLEDGE: SBRT seems effective in terms of LC with acceptable treatment-related toxicities. Therefore, SBRT can be considered a therapeutic option at least in selected patients with CC, possibly combined with adjuvant chemotherapy (CHT).
Authors: Tamara Z Vern-Gross; Anand T Shivnani; Ke Chen; Christopher M Lee; Jonathan D Tward; O Kenneth MacDonald; Christopher H Crane; Mark S Talamonti; Louis L Munoz; William Small Journal: Int J Radiat Oncol Biol Phys Date: 2010-10-23 Impact factor: 7.038
Authors: Rafael A Ibarra; Daniel Rojas; Laura Snyder; Min Yao; Jeffrey Fabien; Michael Milano; Alan Katz; Karyn Goodman; Kevin Stephans; Galal El-Gazzaz; Federico Aucejo; Charles Miller; John Fung; Simon Lo; Mitchell Machtay; Juan R Sanabria Journal: Acta Oncol Date: 2012-01-23 Impact factor: 4.089
Authors: A Paiman Ghafoori; John W Nelson; Christopher G Willett; Junzo Chino; Douglas S Tyler; Herbert I Hurwitz; Hope E Uronis; Michael A Morse; Robert W Clough; Brian G Czito Journal: Int J Radiat Oncol Biol Phys Date: 2010-09-23 Impact factor: 7.038
Authors: Francesco Antonio Polistina; Rosabianca Guglielmi; Cristina Baiocchi; Paolo Francescon; Paolo Scalchi; Antonio Febbraro; Giorgio Costantin; Giovanni Ambrosino Journal: Radiother Oncol Date: 2011-05-27 Impact factor: 6.280
Authors: Daniel T Chang; Devin Schellenberg; John Shen; Jeff Kim; Karyn A Goodman; George A Fisher; James M Ford; Terry Desser; Andrew Quon; Albert C Koong Journal: Cancer Date: 2009-02-01 Impact factor: 6.860
Authors: Kyle E Rusthoven; Brian D Kavanagh; Higinia Cardenes; Volker W Stieber; Stuart H Burri; Steven J Feigenberg; Mark A Chidel; Thomas J Pugh; Wilbur Franklin; Madeleine Kane; Laurie E Gaspar; Tracey E Schefter Journal: J Clin Oncol Date: 2009-03-02 Impact factor: 44.544
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802