Thomas B Brunner1, Oliver Blanck2, Victor Lewitzki3, Nasrin Abbasi-Senger4, Felix Momm5, Oliver Riesterer6, Marciana Nona Duma7, Stefan Wachter8, Wolfgang Baus9, Sabine Gerum10, Matthias Guckenberger11, Eleni Gkika12. 1. Department of Radiation Oncology, University Hospitals Freiburg, Germany; Department of Radiation Oncology, Otto-von-Guericke-University, Magdeburg, Germany. Electronic address: Thomas.brunner@med.ovgu.de. 2. Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Germany. Electronic address: oliver@blanck.de. 3. Department of Radiation Oncology, University Würzburg, Germany. Electronic address: Lewitzki_v@ukw.de. 4. Department of Radiation Oncology, Friedrich-Schiller-University Jena, Germany. Electronic address: Nasrin.Abbasi-Senger@med.uni-jena.de. 5. Department of Radiation Oncology, Offenburg Hospital, Germany. Electronic address: Felix.Momm@og.ortenau-klinikum.de. 6. University Hospital Zürich, Department of Radiation Oncology, Switzerland. Electronic address: oliver.riesterer@usz.ch. 7. Institute of Innovative Radiotherapy, Department of Radiation Sciences, Helmholtz Zentrum Munich, Germany; Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Germany. Electronic address: Marciana-Nona.Duma@mri.tum.de. 8. Klinikum Passau, Radiation Oncology, Germany. Electronic address: Stefan.Wachter@klinikum-passau.de. 9. University Hospital of Cologne, Department of Radiation-Oncology, Germany. Electronic address: wolfgang.baus@uk-koeln.de. 10. Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany. Electronic address: Sabine.Gerum@med.uni-muenchen.de. 11. University Hospital Zürich, Department of Radiation Oncology, Switzerland. Electronic address: Matthias.Guckenberger@usz.ch. 12. Department of Radiation Oncology, University Hospitals Freiburg, Germany. Electronic address: eleni.gkika@uniklinik-freiburg.de.
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.
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.
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