TY - JOUR
T1 - Dose escalation of radiotherapy in unresectable extrahepatic cholangiocarcinoma
AU - Elganainy, Dalia
AU - Holliday, Emma B.
AU - Taniguchi, Cullen M.
AU - Smith, Grace L.
AU - Shroff, Rachna
AU - Javle, Milind
AU - Raghav, Kanwal
AU - Kaseb, Ahmed
AU - Aloia, Thomas A.
AU - Vauthey, Jean Nicolas
AU - Tzeng, Ching Wei D.
AU - Herman, Joseph M.
AU - Koong, Albert C.
AU - Krishnan, Sunil X.
AU - Minsky, Bruce D.
AU - Crane, Christopher H.
AU - Das, Prajnan
AU - Koay, Eugene J.
N1 - Funding Information:
We gratefully acknowledge support from the Andrew Sabin Family Fellowship, Center for Radiation Oncology Research, the Sheikh Ahmed Center for Pancreatic Cancer Research, institutional funds from The University of Texas MD Anderson Cancer Center, GE Healthcare, Philips Healthcare, and Cancer Center Support (Core) Grant CA016672 from the National Cancer Institute to MD Anderson. Dr. Eugene Koay was also supported by NIH (U54CA210181-01, U01CA200468, and U01CA196403), the Pancreatic Cancer Action Network (14-20-25-KOAY, 16-65-SING), Project Purple, and the Radiological Society of North America (RSD1429).
Publisher Copyright:
© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/10
Y1 - 2018/10
N2 - 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.
AB - 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.
KW - dose escalation
KW - extrahepatic cholangiocarcinoma
KW - radiation therapy
KW - toxicity
KW - unresectable extrahepatic cholangiocarcinoma
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U2 - 10.1002/cam4.1734
DO - 10.1002/cam4.1734
M3 - Article
C2 - 30152073
AN - SCOPUS:85052833844
VL - 7
SP - 4880
EP - 4892
JO - Cancer Medicine
JF - Cancer Medicine
SN - 2045-7634
IS - 10
ER -