Abstract
BackgroundTo explore the patterns of failures and areas at highest risk of recurrence for postoperative intrahepatic cholangiocarcinoma (IHCC), with the aim to guide IHCC adjuvant radiotherapy.MethodsPatients with IHCC who had undergone radical surgery at our institution from July 2010 to August 2017 were retrospectively analyzed. The survival and prognostic factors were analyzed by univariate and multivariate analysis. All sites of recurrence were found out and classified as the surgical margin, regional lymph nodes, liver remnant and distant metastasis. According to the recurring area at highest risk, the target volume of adjuvant radiotherapy was proposed.ResultsThe median follow-up time was 23.5 months (2–85 months). The median recurrence free survival (RFS) and overall survival (OS) were 12.1 months and 24.8 months, respectively. Seventy-three (73/127, 57.5%) IHCC patients developed tumor recurrence. Initial recurrences occurred in the potential postoperative radiotherapy (PORT) volume, remnant liver and distant sits were 46 (46/73, 63.0%), 36 (36/73, 49.3%) and 22 (22/73, 30.1%) cases, respectively. Of the 46 patients whose initial recurrence inside the potential PORT volume, 29 (29/73, 39.7%) developed recurrence only inside the potential PORT volume, including 13 tumor bed recurrences, 7 lymph node metastases, and 9 with both tumor bed recurrences and lymph node metastases. The most common lymph node metastases sites were nodes around the abdominal aorta, followed by lymph nodes along the celiac artery, the common hepatic artery, and in the hepatoduodenal ligament.ConclusionsHigh proportion of the recurrences occurred only inside the potential PORT volume, implying adjuvant radiotherapy might improve the local-regional control. Surgical margins and lymph node stations No.16a2, 9, 8, 12, 13, and 14 are suggested to be included in the radiation volume.
Highlights
To document the patterns of failure,identify sites at highest risk of recurrence following curative resection of intrahepatic cholangiocarcinoma (IHCC), in order to guide adjuvant postoperative radiotherapy (PORT)
The mainstay of treatment of IHCC is surgical excision, definitive roles for adjuvant chemotherapy and radiotherapy have not been found, both are used in daily practice [10, 11]
The results showed that chemotherapy did not change the prognosis of all patients with intrahepatic cholangiocarcinoma, but the subgroup with high risk of recurrence can benefit from chemotherapy [27]
Summary
To document the patterns of failure,identify sites at highest risk of recurrence following curative resection of intrahepatic cholangiocarcinoma (IHCC), in order to guide adjuvant postoperative radiotherapy (PORT). The mainstay of treatment of IHCC is surgical excision, definitive roles for adjuvant chemotherapy and radiotherapy have not been found, both are used in daily practice [10, 11]. Other two small size studies proved the value of adjuvant therapy for postoperative IHCC [13, 14]. Another study conducted by Hammad et al reported that adjuvant radiotherapy was associated with an improved survival for patients with R1/R2 resection, but not for those with R0 resection [16]. Study on IHCC post-operative failure pattern might help to optimize adjuvant treatment strategies. Systematic chemotherapy should be considered if distant metastases are the predominant failure patterns
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