Research progress of radiotherapy for extrahepatic cholangiocarcinoma

Abstract

Abstract: Extrahepatic cholangiocarcinoma has a high risk of local recurrence after surgical resection, so adjuvant therapy is needed to improve relapse-free survival and overall survival, among which radiotherapy is an important treatment. This article reviews the role of adjuvant radiotherapy, neoadjuvant radiotherapy, radical radiotherapy and palliative radiotherapy in the treatment of extrabiliary cholangiocarcinoma. Some studys showed that postoperative adjuvant chemoradiotherapy could improve the disease-free survival and overall survival of patients with extrahepatic cholangiocarcinoma. The results of liver transplantation alone have been disappointing for unresectable hilar cholangiocarcinoma, and neoadjuvant chemoradiotherapy combined with liver transplantation has been explored with encouraging results in unresectable hilar cholangiocarcinoma. For unresectable extrahepatic cholangiocarcinoma, radical chemoradiotherapy prolongs survival. Stenting combined with palliative radiotherapy can improve stent patency and improve the quality of life of patients. Radiotherapy combined with effective multimodal therapy holds promise for improving the survival rate of extrahepatic cholangiocarcinoma.

Key words: Extrahepatic cholangiocarcinoma, Adjuvant radiotherapy, Neoadjuvant radiotherapy, Radical radiotherapy, Palliative radiotherapy

Yang Yongjing, Liu Tingting, Liu Shixin. Research progress of radiotherapy for extrahepatic cholangiocarcinoma[J]. Electronic Journal of Liver Tumor, 2023, 10(3): 83-88.

References

[1] BEN-JOSEF E, GUTHRIE K A, EL-KHOUEIRY A B, et al. SWOG S0809: A PhaseⅡ Intergroup Trial of Adjuvant Capecitabine and Gemcitabine Followed by Radiotherapy and Concurrent Capecitabine in Extrahepatic Cholangiocarcinoma and Gallbladder Carcinoma[J]. J Clin Oncol, 2015, 33(24): 2617-2622.
[2] DOHERTY B, NAMBUDIRI V E, PALMER W C.Update on the diagnosis and treatment of cholangiocarcinoma[J]. Curr Gastroenterol Rep, 2017, 19(1): 2.
[3] ANDERSON C D, PINSON C W, BERLIN J, et al.Diagnosis and treatment of cholangiocarcinoma[J]. Oncologist, 2004, 9(1): 43-57.
[4] JARNAGIN W R, RUO L, LITTLE S A, et al.Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies[J]. Cancer, 2003, 98(8): 1689-1700.
[5] HORGAN A M, AMIR E, WALTER T, et al.Adjuvant therapy in the treatment of biliary tract cancer: A systematic review and meta-analysis[J]. J Clin Oncol, 2012, 30(16): 1934-1940.
[6] MURAKAMI Y, UEMURA K, HAYASIDANI Y, et al.Indication for postoperative adjuvant therapy in biliary carcinoma based on analysis of recurrence and survival after surgical resection[J]. Dig Dis Sci, 2009, 54(6): 1360-1364.
[7] YOSHIOKA Y, OGAWA K, OIKAWA H, et al.Factors influencing survival outcome for radiotherapy for biliary tract cancer: A multicenter retrospective study[J]. Radiother Oncol, 2014, 110(3): 546-552.
[8] TAKAHASHI Y, EBATA T, YOKOYAMA Y, et al.Surgery for recurrent biliary tract cancer: a single-center experience with 74 consecutive resections[J]. Ann Surg, 2015, 262(1): 121-129.
[9] CHENG Q, LUO X, ZHANG B, et al.Predictive factors for prognosis of hilar cholangiocarcinoma: Postresection radiotherapy improves survival[J]. Eur J Surg Oncol, 2007, 33(2): 202-207.
[10] KRASNICK B A, JIN L X, DAVIDSON J T, et al.Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: A multiinstitution analysis from the U.S. extrahepatic biliary malignancy consortium[J]. J Surg Oncol, 2018, 117(3): 363-371.
[11] BONET BELTRÁN M, ALLAL A S, GICH I, et al. Is adjuvant radiotherapy needed after curative resection of extrahepatic biliary tract cancers? A systematic review with a meta-analysis of observational studies[J]. Cancer Treat Rev, 2012, 38(2): 111-119.
[12] HORGAN A M, AMIR E, WALTER T, et al.Adjuvant therapy in the treatment of biliary tract cancer: A systematic review and meta-analysis[J]. J Clin Oncol, 2012, 30(16): 1934-1940.
[13] REN B, GUO Q, YANG Y, et al.A meta-analysis of the efficacy of postoperative adjuvant radiotherapy versus no radiotherapy for extrahepatic cholangiocarcinoma and gallbladder carcinoma[J]. Radiat Oncol, 2020, 15(1): 15.
[14] SHROFF R T, KENNEDY E B, BACHINI M, et al.Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline[J]. J Clin Oncol, 2019, 37(12): 1015-1027.
[15] 中国临床肿瘤学会指导工作委员会. 中国临床肿瘤学会(CSCO)胆道恶性肿瘤诊疗指南[M]. 北京: 人民卫生出版社, 2021.
[16] NCCN. The NCCN hepatobiliary cancer clinical practice guidelines in oncology (Version 5.2021). . The NCCN hepatobiliary cancer clinical practice guidelines in oncology (Version 5.2021). http://www.nccn.org.
[17] SOCHA J, MICHALAK M, WO KIEWICZ G, et al.Nodal areas of potential geographic error in adjuvant radiotherapy for biliary tract cancer[J]. Radiother Oncol, 2017, 125(2): 365-373.
[18] GRENDAR J, GRENDAROVA P, SINHA R, et al.Neoadjuvant therapy for downstaging of locally advanced hilar cholangiocarcinoma: a systematic review[J]. HPB (Oxford), 2014, 16(4): 297-303.
[19] MCMASTERS K M, TUTTLE T M, LEACH S D, et al. Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma[J]. Am J Surg, 1997, 174(6): 605-608; discussion 608-609.
[20] GERHARDS M F, GONZALEZ D G, TEN HOOPEN-NEUMANN H, et al. Prevention of implantation metastases after resection of proximal bileduct tumours with pre-operative low dose radiation therapy[J]. Eur J Surg Oncol, 2000, 26(5): 480-485.
[21] MEYER C G, PENN I, JAMES L.Liver transplantation for cholangiocarcinoma: results in 207 patients[J]. Transplantation, 2000, 69(8): 1633-1637.
[22] HEIMBACH J K, GORES G J, HADDOCK M G, et al.Liver transplantation for unresectable perihilar cholangiocarcinoma[J]. Semin Liver Dis, 2004, 24(2): 201-207.
[23] DARWISH MURAD S, KIM W R, HARNOIS D M, et al.Efficacy of Neoadjuvant Chemoradiation, Followed by Liver Transplantation, for Perihilar Cholangiocarcinoma at 12 US Centers[J]. Gastroenterology, 2012, 143(1): 88-98.
[24] LOVEDAY B P T, KNOX J J, DAWSON L A, et al. Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada[J]. J Surg Oncol, 2018, 117(2): 213-219.
[25] SCHÜLE S, ALTENDORF-HOFMANN A, UTEß F, et al. Liver transplantation for hilar cholangiocarcinoma-a single-centre experience[J]. Langenbecks Arch Surg, 2013, 398(1): 71-77.
[26] JARNAGIN W R, SHOUP M.Surgical management of cholangiocarcinoma[J]. Semin Liver Dis, 2004, 24(2): 189-199.
[27] MOUREAU-ZABOTTO L, TURRINI O, RESBEUT M, et al.Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma[J]. BMC Cancer, 2013, 13: 568.
[28] AUTORINO R, MATTIUCCI G C, ARDITO F, et al.Radiochemotherapy with gemcitabine in unresectable extrahepatic cholangiocarcinoma: Long-term results of a phaseⅡ study[J]. Anticancer Res, 2016, 36: 737-740.
[29] TORGESON A, LLOYD S, BOOTHE D, et al.Chemoradiation Therapy for Unresected Extrahepatic Cholangiocarcinoma: A Propensity Score-Matched Analysis[J]. Ann Surg Oncol, 2017, 24(13): 4001-4008.
[30] DEODATO F, CLEMENTE G, MATTIUCCI G C, et al.Chemoradiation and brachytherapy in biliary tract carcinoma: long-term results[J]. Int J Radiat Oncol Biol Phys, 2006, 64(2): 483-488.
[31] MOMM F, SCHUBERT E, HENNE K, et al.Stereotactic fractionated radiotherapy for Klatskin tumours[J]. Radiother Oncol, 2010, 95(1): 99-102.
[32] POLISTINA F A, GUGLIELMI R, BAIOCCHI C, et al.Chemoradiation treatment with gemcitabine plus stereotactic body radiotherapy for unresectable, non-metastatic, locally advanced hilar cholangiocarcinoma. Results of a five year experience[J]. Radiother Oncol, 2011, 99(2): 120-123.
[33] MAHADEVAN A, DAGOGLU N, MANCIAS J, et al.Stereotactic Body Radiotherapy (SBRT) for Intrahepatic and Hilar Cholangiocarcinoma[J]. J Cancer, 2015, 6(11): 1099-1104.
[34] BRUNNER T B, SEUFFERLEIN T.Radiation therapy in cholangiocellular carcinomas[J]. Best Pract Res Clin Gastroenterol, 2016, 30(4): 593-602.
[35] GKIKA E, HALLAUER L, KIRSTE S, et al.Stereotactic body radiotherapy (SBRT) for locally advanced intrahepatic and extrahepatic cholangiocarcinoma[J]. BMC Cancer, 2017, 17(1): 781.
[36] SHINOHARA E T, MITRA N, GUO M, et al.Radiotherapy is associated with improved survival in adjavant and pallitive treatment of extrahepatic cholangiocarinomas[J]. Int J Radiat Oncol Biol Phys, 2009, 74(4): 1191-1198.
[37] TAMADA K, SUGANO K.Diagnosis and non-surgical treatment of bile duct carcinoma developments in the past decade[J]. J Gastroenterol, 2000, 35(5): 319-325.
[38] BOWLING T E, GALBRAITH S M, HATFIELD A R, et al.Retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma[J]. Gut, 1996, 39(6): 852-855.
[39] TAN Y, ZHU J Y, QIU B A, et al.Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma[J]. Oncol Lett, 2015, 10(4): 2537-2542.
[40] GOLFIERI R, GIAMPALMA E, FUSCO F, et al. Unresectable hilar cholangiocarcinoma: Multimodality treatment with percutaneous and intraluminal plus external radiotherapy[J]. J Chemother, 2004, 16 Suppl 5: 55-57.