Definitive Liver Radiotherapy for Intrahepatic Cholangiocarcinoma with Extrahepatic Metastases

Brian De, Rituraj Upadhyay, Kaiping Liao, Tiffany Kumala, Christopher Shi, Grace Dodoo, Joseph Abi Jaoude, Kelsey L. Corrigan, Gohar S. Manzar, Kathryn E. Marqueen, Vincent Bernard, Sunyoung S. Lee, Kanwal P.S. Raghav, Jean Nicolas Vauthey, Ching Wei Tzeng, Hop S. Tran Cao, Grace Lee, Jennifer Wo, Theodore S. Hong, Christopher H. CraneBruce D. Minsky, Grace L. Smith, Emma B. Holliday, Cullen M. Taniguchi, Albert C. Koong, Prajnan Das, Milind Javle, Ethan B. Ludmir, Eugene Koay

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

INTRODUCTION: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT.

METHODS: We reviewed ICC patients that found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose was 97.5 Gy (interquartile range 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazard modeling.

RESULTS: We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow-up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI: 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; p = 0.001). On multivariable propensity score-matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; p = 0.005) and receipt of L-RT (HR: 0.40; p = 0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; p < 0.001).

CONCLUSION: For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS versus those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted.

Original languageEnglish (US)
Pages (from-to)198-208
Number of pages11
JournalLiver Cancer
Volume12
Issue number3
DOIs
StatePublished - Aug 16 2023

ASJC Scopus subject areas

  • Hepatology
  • Oncology

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