Dose escalation of radiotherapy in unresectable extrahepatic cholangiocarcinoma

Dalia Elganainy, Emma B. Holliday, Cullen M. Taniguchi, Grace L. Smith, Rachna Shroff, Milind Javle, Kanwal Raghav, Ahmed Kaseb, Thomas A. Aloia, Jean Nicolas Vauthey, Ching Wei D. Tzeng, Joseph M. Herman, Albert C. Koong, Sunil X. Krishnan, Bruce D. Minsky, Christopher H. Crane, Prajnan Das, Eugene J. Koay

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Purpose: To evaluate the effect of escalated dose radiation therapy (EDR, defined as doses >50.4 Gy in 28 fractions [59.5 Gy BED]) on overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) of patients with unresectable extrahepatic cholangiocarcinoma (EHCC). Methods: A consecutive cohort of 80 patients who underwent radiotherapy for unresectable EHCC from 2001 to 2015 was identified. Demographic, tumor, treatment, toxicity, and laboratory variables were collected. The maximal RT doses ranged from 30 to 75 Gy (median 50.4 Gy, at 1.8-4.5 Gy/fraction). Gross tumor volume (GTV) coverage by maximal dose in EDR group ranged from 38% to 100%. Kaplan–Meier method was used to estimate OS, FFLP, and FFDP. Univariate and multivariate Cox regression models were analyzed. Results: After radiotherapy, median OS, FFLP, and FFDP were 18.7, 22.6, and 24.3 months, respectively. There was no significant difference in OS or FFLP between patients who received EDR to portions of the GTV and patients who did not. On multivariate analysis, bigger GTV, age, and ECOG performance status were independently associated with shorter OS. Local progression on chemotherapy prior to RT was independently associated with shorter FFLP. High baseline neutrophil/lymphocyte ratio (>5.3) was independently associated with shorter FFDP. Toxicity grades were similar in EDR and lower doses except lymphopenia which was higher in EDR (P = 0.053). Conclusions: EDR to selective portions of the GTV may not benefit patients with unresectable EHCC despite having acceptable toxicity. New methods to improve local control and survival for unresectable EHCC are needed.

Original languageEnglish (US)
Pages (from-to)4880-4892
Number of pages13
JournalCancer Medicine
Issue number10
StatePublished - Oct 2018


  • dose escalation
  • extrahepatic cholangiocarcinoma
  • radiation therapy
  • toxicity
  • unresectable extrahepatic cholangiocarcinoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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