Carbon-ion radiotherapy for cholangiocarcinoma: a multi-institutional study by and the Japan carbon-ion radiation oncology study group (J-CROS)
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Goro Kasuya1, Kazuki Terashima2, Kei Shibuya3, Shingo Toyama4, Daniel K. Ebner1,5, Hiroshi Tsuji1, Tomoaki Okimoto2, Tatsuya Ohno3, Yoshiyuki Shioyama6, Takashi Nakano1, Tadashi Kamada1 and the Japan Carbon-Ion Radiation Oncology Study Group
1 QST Hospital (Former Hospital of the National Institute of Radiological Sciences), National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
2 Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
3 Gunma University Heavy Ion Medical Center, Maebashi, Japan
4 Ion Beam Therapy Center, SAGA-HIMAT Foundation, Tosu, Japan
5 Harvard TH Chan School of Public Health, Boston, MA, USA
6 Department of Radiology, Kyushu University, Hakata, Japan
Keywords: carbon-ion radiotherapy; radiation; cholangiocarcinoma; adverse event; survival
Received: March 06, 2019 Accepted: June 05, 2019 Published: July 09, 2019
To evaluate the safety and efficacy of carbon-ion radiotherapy (CIRT) for cholangiocarcinoma via a multicenter retrospective study. Clinical data were collected from patients with cholangiocarcinoma who had received CIRT at one of four treating institutions in Japan. Of 56 eligible patients, none received surgery for cholangiocarcinoma before or after CIRT. The primary endpoint was overall survival (OS). Based on the tumor site, the 56 cases were categorized as intrahepatic cholangiocarcinoma (IHC) (n=27) or perihilar cholangiocarcinoma (PHC) (n=29). In all patients, the median tumor size was 37 (range, 15‒110) mm, and the most commonly prescribed dose was 76 Gy (relative biological effectiveness) in 20 fractions. The median survival was 14.8 (range, 2.1-129.2) months, and the 1- and 2-year OS rates were 69.7% and 40.9%, respectively. The median survival times of the patients with IHC and those with PHC were 23.8 and 12.6 months, respectively. Both univariate and multivariate analyses revealed that cholangitis pre-CIRT and Child‒Pugh class B were significant prognostic factors for an unfavorable OS. Of four patients who died of liver failure, one with IHC was suspected to have radiation-induced liver disease because of newly developed ascites, and died at 4.3 months post-CIRT. Grade 3 CIRT-related bile duct stenosis was observed in one IHC case. No other CIRT-related severe adverse events, including gastrointestinal events, were observed. These results suggest that CIRT yields relatively favorable treatment outcomes, especially for patients with IHC, and acceptable toxicities were observed in patients with cholangiocarcinoma who did not receive surgery.
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