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Jia AY, Wu JX, Zhao YT, Li YX, Wang Z, Rong WQ, Wang LM, Jin J, Wang SL, Song YW, Liu YP, Ren H, Fang H, Wang WQ, Liu XF, Yu ZH, Wang WH. Intensity-modulated radiotherapy following null-margin resection is associated with improved survival in the treatment of intrahepatic cholangiocarcinoma. J Gastrointest Oncol 2015; 6:126-33. [PMID: 25830032 DOI: 10.3978/j.issn.2078-6891.2014.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The current study is the first to examine the effectiveness and toxicity of postoperative intensity-modulated radiotherapy (IMRT) in the treatment of intrahepatic cholangiocarcinoma (ICC) abutting the vasculature. Specifically, we aim to assess the role of IMRT in patients with ICC undergoing null-margin (no real resection margin) resection. METHODS Thirty-eight patients with ICC adherent to major blood vessels were included in this retrospective study. Null-margin resection was performed on all patients; 14 patients were further treated with IMRT. The median radiation dose delivered was 56.8 Gy (range, 50-60 Gy). The primary endpoints were overall survival (OS) and disease-free survival (DFS). RESULTS At a median follow-up of 24.6 months, the median OS and DFS of all patients (n=38) were 17.7 months (95% CI, 13.2-22.2) and 9.9 months (95% CI, 2.8-17.0), respectively. Median OS was 21.8 months (95% CI, 15.5-28.1) among the 14 patients in the postoperative IMRT group and 15.0 months (95% CI, 9.2-20.9) among the 24 patients in the surgery-only group (P=0.049). Median DFS was 12.5 months (95% CI, 6.8-18.2) in the postoperative IMRT group and 5.5 months (95% CI, 0.7-12.3) in the surgery-only group (P=0.081). IMRT was well-tolerated. Acute toxicity included one case of Grade 3 leukopenia; late toxicity included one case of asymptomatic duodenal ulcer discovered through endoscopy. CONCLUSIONS The study results suggest that postoperative IMRT is a safe and effective treatment option following null-margin resections of ICC. Larger prospective and randomized trials are necessary to establish postoperative IMRT as a standard practice for the treatment of ICC adherent to major hepatic vessels.
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Affiliation(s)
- Angela Y Jia
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Jian-Xiong Wu
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Yu-Ting Zhao
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Ye-Xiong Li
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Zhi Wang
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Wei-Qi Rong
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Li-Ming Wang
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Jing Jin
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Shu-Lian Wang
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Yong-Wen Song
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Yue-Ping Liu
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Hua Ren
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Hui Fang
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Wen-Qing Wang
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Xin-Fan Liu
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Zi-Hao Yu
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
| | - Wei-Hu Wang
- 1 Department of Medicine, Weill Cornell Medical College, New York City, NY, USA ; 2 Department of Abdominal Surgery, 3 Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
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