Consideration of the role of radiotherapy for unresectable intrahepatic cholangiocarcinoma: A retrospective analysis of 75 patients

The role of radiotherapy in the treatment of intrahepatic cholangiocarcinoma is controversial. We undertook this study to determine if radiotherapy is appropriate for patients with unresectable or lymph node metastatic intrahepatic cholangiocarcinoma. METHODS AND MATERIALS The records of 75 patients with intrahepatic cholangiocarcinoma were reviewed and analyzed by Kaplan-Meier method and Cox proportional hazards analysis. Thirty-eight patients who received limited local external-beam radiotherapy were classified as the radiotherapy group. This group included nine patients with resected intrahepatic cholangiocarcinoma with macroscopic residual lymph nodes receiving postoperative external-beam radiotherapy, seven patients with postoperative recurrences in lymph nodes receiving external-beam radiotherapy for salvage failure after treatment with surgery alone, and 22 patients with unresectable intrahepatic cholangiocarcinoma. The median total dose was 50 Gy (range, 30-60 Gy) in daily doses of 2 Gy/fraction, five times a week. Thirty-seven patients with intrahepatic cholangiocarcinoma (including 14 with resectable disease and synchronous or asynchronous lymph node metastases, and 23 with unresectable disease) who did not receive external-beam radiotherapy were selected from hospitalized patients in the same period and were classified as the nonexternal-beam radiotherapy group. Parameters observed included survival rates and tumor response to external-beam radiotherapy demonstrated both by clinical symptoms and by computed tomography scan/magnetic resonance image. RESULTS Objective responses to external-beam radiotherapy were 36.4% for intrahepatic tumors in 22 patients with unresectable intrahepatic cholangiocarcinoma, and 52% for lymph node metastases in 25 patients with resectable or unresectable intrahepatic cholangiocarcinoma. Pain was relieved in 90% of the patients who received external-beam radiotherapy. The survival rates at 1 and 2 years for patients with unresectable intrahepatic cholangiocarcinoma treated with external-beam radiotherapy (n = 22) compared with those who did not receive external-beam radiotherapy (n = 23) were 36.1% versus 19.0% and 5.2% versus 4.7%, respectively (log-rank P = 0.021). The survival experience of the 16 patients with lymph node metastases (synchronous or asynchronous) who underwent hepatectomy combined with external-beam radiotherapy was superior to that of the group (n = 14) who did not receive external-beam radiotherapy (median survival, 468 and 211 days, respectively; log-rank P = 0.075). These results show that external-beam radiotherapy influenced the survival in the patients with unresectable intrahepatic cholangiocarcinoma or lymph node metastases. The most common reason for death was liver failure caused by uncontrolled intrahepatic disease. Grade 3 toxicity in the external-beam radiotherapy group was infrequent. CONCLUSION External-beam radiotherapy seems to improve the prognosis of patients with unresectable intrahepatic cholangiocarcinoma and deserves further study.