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KMID : 0859320090270040181
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2009 Volume.27 No. 4 p.181 ~ p.188
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The Results of Postoperative Radiation Therapy for Perihilar Cholangiocarcinoma
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Lee Yu-Sun
Park Jae-Won
Park Jin-Hong
Choi Eun-Kyung
Ahn Seung-Do
Lee Sang-Wook
Song Si-Yeol
Lee Seung-Gyu
Hwang Shin
Lee Young-Joo
Park Kwang-Min
Kim Ki-Hun
Ahn Chul-Soo
Moon Deok-Bog
Chang Heung-Moon
Ryu Min-Hee
Kim Tae-Won
Lee Jae-Lyun
Kim Jong-Hoon
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Abstract
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Purpose: The aim of this study was to evaluate the results of postoperative radiotherapy in a case of perihilar cholagiocarcinoma by analyzing overall survival rate, patterns of failure, prognostic factors for overall survival, and toxicity.
Materials and Methods : Between January 1998 and March 2008, 38 patients with perihilar cholangiocarcinoma underwent a surgical resection and adjuvant radiotherapy. The median patient age was 59 years (range, 28 to 72 years), which included 23 men and 15 women. The extent of surgery was complete resection in 9 patients, microscopically positive margins in 25 patients, and a subtotal resection in 4 patients. The tumor bed and regional lymphatics initially received 45 Gy or 50 Gy, but was subsequently boosted to a total dose of 59.4 Gy or 60 Gy in incompletely resected patients. The median radiotherapy dose was 59.4 Gy. Concurrent chemotherapy was administered in 30 patients. The median follow-up period was 14 months (range, 6 to 45 months).
Results: The 3-year overall survival and 3-year progression free survival rates were 30% and 8%, respectively. The median survival time was 28 months. A multivariate analysis showed that differentiation was the only significant factor for overall survival. The 3-year overall survival was 34% in R0 patients and 20% in R1 patients. No statistically significant differences in survival were found between the 2 groups (p=0.3067). The first site of failure was local in 18 patients (47%). No patient experienced grade 3 or higher acute toxicity and duodenal bleeding developed in 2 patients.
Conclusion: Our results suggest that adjuvant RT might be a significant factor in patients with a positive margin following a radical resection. However, there was still a high locoregional recurrence rate following surgery and postoperative radiotherapy. Further study is necessary to enhance the effect of the adjuvant radiotherapy.
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KEYWORD
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Perihilar cholangiocarcinoma, Operation, Radiation therapy
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