Chemoradiation for locally advanced perihilar cholangiocarcinoma.

Abstract

372 Background: Locally advanced perihilar cholangio-carcinoma (LA-PHC) is a rare malignancy with dismal prognosis, and chemoradiation (CRT) is used to palliate symptoms and extend survival. However, its role has not been established due to the rarity of these tumors. We intended to investigate the efficacy of chemo-concurrent radiotherapy (CRT) for patients with LA-PHC. Methods: This study included 52 patients who received CRT for LAPHC in a single institue. Patients received external beam radiotherapy with a median dose of 50.4Gy (range, 720-5400) with gemcitabine or 5-FU (or its analogues). The objective response rate (ORR), disease control rate (DCR), and overall survival (OS) were evaluated. All statistical analysis were performed by SPSS program version 18.0. Results: The median OS was 14.2 months (95% CI, 8.9~19.5). The ORR and DCR was 12% and 85%, respectively. Thirteen patients (19%) whose disease were converted to resectable after CRT had a significant survival advantage compared to patients who underwent CRT alone (29.2 vs. 10.8 months, P=0.005). CA 19-9 response (defined as more than 30% decrease in the CA 19-9 level compared to baseline) at 1month after CRT predicted prolonged survival (Table). CRT was generally well tolerated. Although gemcitabine-based CRT had a higher ORR, DCR, and CA 19-9 response at 1 month than 5FU-based CRT, the difference was not statistically different, and there was no difference in OS between two regimens. Moreover, patients treated with gemcitabine based CRT suffered more severe hematologic toxicity (grade 3 or 4 neutropenia, 20% vs. 4%). Conclusions: This study suggested that CRT is a good therapeutic option in the treatment of LA-PHC. Also, CA 19-9 response 1 month after completion of CRT was identified as a predictive marker of survival in patients who underwent CRT. Further research is warranted regarding optimal chemotherapy regimen, and schedule of radiation. [Table: see text]