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. 2015 Apr;6(2):126-33.
doi: 10.3978/j.issn.2078-6891.2014.102.

Intensity-modulated radiotherapy following null-margin resection is associated with improved survival in the treatment of intrahepatic cholangiocarcinoma

Angela Y Jia  1 , Jian-Xiong Wu  1 , Yu-Ting Zhao  1 , Ye-Xiong Li  1 , Zhi Wang  1 , Wei-Qi Rong  1 , Li-Ming Wang  1 , Jing Jin  1 , Shu-Lian Wang  1 , Yong-Wen Song  1 , Yue-Ping Liu  1 , Hua Ren  1 , Hui Fang  1 , Wen-Qing Wang  1 , Xin-Fan Liu  1 , Zi-Hao Yu  1 , Wei-Hu Wang  1
Affiliations

Intensity-modulated radiotherapy following null-margin resection is associated with improved survival in the treatment of intrahepatic cholangiocarcinoma

Angela Y Jia et al. J Gastrointest Oncol. 2015 Apr.

Abstract

Background: The current study is the first to examine the effectiveness and toxicity of postoperative intensity-modulated radiotherapy (IMRT) in the treatment of intrahepatic cholangiocarcinoma (ICC) abutting the vasculature. Specifically, we aim to assess the role of IMRT in patients with ICC undergoing null-margin (no real resection margin) resection.

Methods: Thirty-eight patients with ICC adherent to major blood vessels were included in this retrospective study. Null-margin resection was performed on all patients; 14 patients were further treated with IMRT. The median radiation dose delivered was 56.8 Gy (range, 50-60 Gy). The primary endpoints were overall survival (OS) and disease-free survival (DFS).

Results: At a median follow-up of 24.6 months, the median OS and DFS of all patients (n=38) were 17.7 months (95% CI, 13.2-22.2) and 9.9 months (95% CI, 2.8-17.0), respectively. Median OS was 21.8 months (95% CI, 15.5-28.1) among the 14 patients in the postoperative IMRT group and 15.0 months (95% CI, 9.2-20.9) among the 24 patients in the surgery-only group (P=0.049). Median DFS was 12.5 months (95% CI, 6.8-18.2) in the postoperative IMRT group and 5.5 months (95% CI, 0.7-12.3) in the surgery-only group (P=0.081). IMRT was well-tolerated. Acute toxicity included one case of Grade 3 leukopenia; late toxicity included one case of asymptomatic duodenal ulcer discovered through endoscopy.

Conclusions: The study results suggest that postoperative IMRT is a safe and effective treatment option following null-margin resections of ICC. Larger prospective and randomized trials are necessary to establish postoperative IMRT as a standard practice for the treatment of ICC adherent to major hepatic vessels.

Keywords: Radiotherapy; intensity-modulated; intrahepatic cholangiocarcinoma (ICC); null-margin resection; postoperative radiotherapy.

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Figures

Figure 1
Figure 1
Representative case of an ICC patient undergoing null-margin resection. (A) Magnetic resonance imaging showed a 2 cm primary tumor located in Couinaud segment VIII that is adherent to the portal vein; (B) contrast computed tomography (CT) scan after surgery revealed silver markers stitched onto the tumor cutting bed used to orient the clinical tumor volume for IMRT planning. ICC, intrahepatic cholangiocarcinoma; IMRT, intensity-modulated radiotherapy.
Figure 2
Figure 2
Overall survival (OS) and disease-free survival (DFS) of all patients (n=38).
Figure 3
Figure 3
(A) Overall survival (OS) and (B) disease-free survival (DFS) of patients undergoing surgery-only (n=24) or surgery plus IMRT (n=14). IMRT, intensity-modulated radiotherapy.
See this image and copyright information in PMC

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