@article{e67f0bea4b624e24aa911205817408f4,
title = "Definitive Liver Radiotherapy for Intrahepatic Cholangiocarcinoma with Extrahepatic Metastases",
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.",
author = "Brian De and Rituraj Upadhyay and Kaiping Liao and Tiffany Kumala and Christopher Shi and Grace Dodoo and {Abi Jaoude}, Joseph and Corrigan, {Kelsey L.} and Manzar, {Gohar S.} and Marqueen, {Kathryn E.} and Vincent Bernard and Lee, {Sunyoung S.} and Raghav, {Kanwal P.S.} and Vauthey, {Jean Nicolas} and Tzeng, {Ching Wei} and {Tran Cao}, {Hop S.} and Grace Lee and Jennifer Wo and Hong, {Theodore S.} and Crane, {Christopher H.} and Minsky, {Bruce D.} and Smith, {Grace L.} and Holliday, {Emma B.} and Taniguchi, {Cullen M.} and Koong, {Albert C.} and Prajnan Das and Milind Javle and Ludmir, {Ethan B.} and Eugene Koay",
note = "Funding Information: This work was supported in part by Cancer Center Support (Core) grant P30 CA016672 from the National Cancer Institute, National Institutes of Health, to the University of Texas MD Anderson Cancer Center. BD was supported by the RSNA Research & Education Foundation through grant number RR2111. EK was supported by DOD (W81XWH-21-1-0709) and NIH (U54CA210181, U54CA143837, U01CA196403, U01CA200468, U01CA200468, U01CA214263, P50CA221707, R01CA221971, R01CA218004, P30CA016672). EBL was supported by the Andrew Sabin Family Fellowship and the Fund for Innovation in Cancer Informatics. Funding Information: BD reports consulting honoraria from Sermo Inc. EBH reports research funding from Merck Serono. CT reports a consulting/advisory role with Accuray. EJK reports grants from National Institutes of Health, Stand Up 2 Cancer, MD Anderson Cancer Center, Philips Healthcare, Elekta, and GE Healthcare; personal fees from RenovoRx and Taylor and Francis; and a consulting/advisory role with Augmenix. ACK reports ownership of shares in Aravive, Inc. PD reports consulting/advisory relationships with the American Society for Radiation Oncology and the National Cancer Institute. All reported conflicts are outside of the submitted work. Publisher Copyright: {\textcopyright} 2023 The Author(s). Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.",
year = "2023",
month = aug,
day = "16",
doi = "10.1159/000530134",
language = "English (US)",
volume = "12",
pages = "198--208",
journal = "Liver Cancer",
issn = "2235-1795",
publisher = "S. Karger AG",
number = "3",
}