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. 2017 Feb;8(1):180-186.
doi: 10.21037/jgo.2017.01.20.

High dose chemoradiation for unresectable hilar cholangiocarcinomas using intensity modulated external beam radiotherapy: a single tertiary care centre experience

Reena Engineer  1 , Shaesta Mehta  2 , Nikhil Kalyani  1 , Suresh Chaudhari  3 , Tejas Dharia  4 , Nitin Shetty  4 , Supriya Chopra  1 , Mahesh Goel  5 , Suyash Kulkarni  4 , Shyam Kishore Shrivastava  1
Affiliations

High dose chemoradiation for unresectable hilar cholangiocarcinomas using intensity modulated external beam radiotherapy: a single tertiary care centre experience

Reena Engineer et al. J Gastrointest Oncol. 2017 Feb.

Abstract

Background: We present results of patients diagnosed with unresectable hilar cholangiocarcinomas treated with high dose radiotherapy and concurrent chemotherapy.

Methods: From Aug 2005 to Dec 2012, 68 consecutive patients were treated. Fifty patients (group 1) presenting to us with obstructive jaundice were planned for endobiliary brachytherapy (EBBT 14 Gy) followed external beam radiotherapy (EBRT 45 Gy). Twenty-two patients (group 2) who had previously undergone biliary drainage underwent EBRT (57 Gy). All patients received injection Gemcitabine 300 mg/m2/weekly along with EBRT.

Results: Twenty-nine patients in group 1 and 22 patients in group 2 completed the treatment. Twenty-six (55%) patients achieved complete radiological response, 16 (64%) belonging to group 1 and 8 (44%) of group 2 (P=0.05). The median overall survival (MOS) was 17.5 and 16 months for group 1 and 2 respectively (P=0.07). The 1- and 2-year survival was 63%, and 18% for group I and 61% and 22% for group II respectively. The MOS was 5 months and 1 year survival was 14% for patients receiving EBBT only. MOS was significantly better after complete response (P=0.001).

Conclusions: Intensity modulated radiotherapy (IMRT) modulated high dose radiotherapy used either alone or with brachytherapy demonstrates potential to prolonged overall survival in unresectable hilar cholangiocarcinomas.

Keywords: Klatskin tumor; chemoradiation; intensity modulated radiotherapy (IMRT).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan Meier curves for type of radiation and overall survival. MOS, median overall survival.
Figure 2
Figure 2
Response to radiation and survival (P=0.001).
See this image and copyright information in PMC

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