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. 2021 Jun 16;16(6):e0253285.
doi: 10.1371/journal.pone.0253285. eCollection 2021.

Radiation therapy for recurrent extrahepatic bile duct cancer

Minji Koh  1 , Jin-Hong Park  1 , Changhoon Yoo  2 , Sang Min Yoon  1 , Jinhong Jung  1 , Baek-Yeol Ryoo  2 , Heung-Moon Chang  2 , Kyu-Pyo Kim  2 , Jae Ho Jeong  2 , Jong Hoon Kim  1
Affiliations

Radiation therapy for recurrent extrahepatic bile duct cancer

Minji Koh et al. PLoS One. .

Abstract

Purpose: More than half of patients with bile duct cancer (BDC) develop recurrence even after curative resection. Recurrent BDC has a poor prognosis, and no optimal treatment modality has been established. We therefore analyzed our experience on the survival outcomes of radiation therapy (RT) for recurrent extrahepatic bile duct cancer (EHBDC).

Patients and methods: We retrospectively analyzed the records of patients with recurrent EHBDC who underwent concurrent chemoradiation therapy (CCRT) or RT alone at our institution between January 2001 and June 2015. Freedom from locoregional progression (FFLP), progression-free survival (PFS), and overall survival (OS) were assessed, and univariate and multivariate analyses were performed to identify the prognostic factors.

Results: A total of 76 patients were included in the analysis. The median OS was 16 months and the rates of 2-year FFLP, PFS, and OS were 61%, 25%, and 33%, respectively. Among the evaluable patients, the first site of failure was the locoregional area in 16 patients, distant metastasis in 27, and both sites in 8. On univariate analysis, disease-free interval (p = 0.012) and concurrent chemotherapy (p = 0.040) were found as significant prognostic factors for OS. One patient with CCRT developed a grade 3 hematologic toxicity, and two patients experienced late grade 3 toxicities including duodenal ulcer bleeding and obstruction.

Conclusions: RT for recurrent EHBDC showed favorable survival and local control with limited treatment-related toxicities. Considering that the most common pattern of failure was distant metastasis, further studies on the optimal scheme of chemotherapy and RT are warranted.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival and recurrence of the study patients.
(a) Freedom from locoregional progression (FFLP). (b) Progression-free survival (PFS). (c) Overall survival (OS).
Fig 2
Fig 2. Survival and recurrence of the study patients.
(a) Freedom from locoregional progression (FFLP), (b) Progression-free survival (PFS), (c) Overall survival (OS) according to biologically effective dose, and (d) FFLP, (e) PFS, (f) OS according to concurrent chemotherapy.
Fig 3
Fig 3. Pattern of failure.
See this image and copyright information in PMC

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