Abstract
Aim: To present a systematic review on efficacy and toxicity of modern concurrent chemoradiation (CCRT) in unresectable biliary tract cancers (BTC). Methods: A systematic review of literature published within the last ten years (1 January 2007-31 December 2017), based on PRISMA methodology and using PubMed electronic database was conducted. Only articles reporting patients’ outcome in terms of toxicity and/or overall survival (OS) or progression-free survival (PFS) after CCRT, with or without other treatments, were analyzed. Only studies of patients with diagnosis of unresectable BTC, including intrahepatic, extrahepatic, and gallbladder neoplasm were considered. Results: Six eligible studies were included reporting data on 195 patients. Median follow-up ranged between 9.4 and 27.7 months (median: 16 months). Four studies were prospective phase II trials and 2 had a retrospective design. Different external beam radiotherapy (EBRT) techniques and chemotherapy (CT) schedules were used while only in one study a brachytherapy boost was delivered. Grade ≥ 3 acute toxicity (hematological or gastrointestinal) ranged between 0.0 and 55.6% (median: 37.0%). One study reported 30.0% gastrointestinal grade ≥ 2 late toxicity. PFS ranged between 6.8 and 10.5 months (median: 7.5 months) in 5 studies. OS ranged between 9.6 and 13.5 months (median: 13 months) in 5 studies. Conclusion: CCRT remains a reasonable treatment option for locally advanced BTC, providing results comparable with the ones of standard CT, particularly in terms of OS. Considering the progressive advance of modern EBRT techniques, further improvement of these results can be expected. Therefore, clinical trials based on advanced radiotherapy techniques and new integrations of CCRT with systemic treatments are warranted.
Highlights
Biliary tract cancers (BTC) are rare malignancies, representing less than 3% of all gastrointestinal cancers and 10-15% of all primary hepatobiliary cancers
From the literature search as described above, 60 articles were identified from the database, and 15 papers were retrieved from other sources
Thorough screening at title and abstract level, 20 articles were selected for full text reading and only 6 were considered eligible for inclusion
Summary
Biliary tract cancers (BTC) are rare malignancies, representing less than 3% of all gastrointestinal cancers and 10-15% of all primary hepatobiliary cancers. They are classified as: i) intrahepatic cholangiocarcinoma (ICC), originating from biliary three epithelia inside the liver; ii) extrahepatic cholangiocarcinoma (ECC), originating outside the liver parenchyma and further divided into proximal (or Klatskin’s tumor) and distal; iii) gallbladder (GB) cancers, originating from gallbladder neck or fundus [1]. Complete resection is the mainstay of operable BTC but most patients are not candidates for curative surgery [1]. BTC are often diagnosed in advanced stages due to the aggressive nature of these tumors and nonspecific symptoms. Local and distant failures are frequent justifying the use of adjuvant treatments [1], standard postoperative strategies have not been clearly defined
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