Impact of radiotherapy in the management of locally advanced extrahepatic cholangiocarcinoma
Menée à partir de données portant sur 30 patients atteints d'un cholangiocarcinome extra-hépatique non résécable de stade localement avancé (durée médiane de suivi : 12 mois), cette étude française évalue l'efficacité, du point de vue de la survie sans progression à 1 et 3 ans, et la toxicité d'une radiothérapie externe conformationnelle 3D en combinaison ou non avec une chimiothérapie
Objectives : Optimal therapy for patients with unresectable locally advanced extrahepatic cholangiocarcinoma (ULAC) remains controversial. We analysed the role of radiotherapy in the management of such tumors. Methods : We retrospectively reviewed the charts of patients treated in our institution with conformal-3D external-beam-radiotherapy (EBRT) with or without concurrent chemotherapy. Results : Thirty patients were included: 24 with a primary tumor (group1) and 6 with a local relapse (group2). Toxicity was low. Among 25 patients assessable for EBRT response, we observed 9 complete responses, 4 partial responses, 10 stabilisations, and 2 progressions. The median follow-up was 12 months. Twenty out of 30 patients (66%) experienced a relapse, which was metastatic in 75% of cases in the whole series, 87% in group1, 60% in group2 (p = 0.25). Twenty-eight patients (93%) died of relapse or disease complications. Median overall survivals in the whole group and in group1 or 2 were respectively 12, 11 and 21 months (p = 0.11). The 1-year and 3-year progression-free survivals were respectively 38% and 16% in the whole series; 31% and 11% in group1, 67% and 33% in group2 (p = 0.35). Conclusion : EBRT seems efficient to treat ULAC, with acceptable toxicity. For primary disease, the high rate of metastatic relapse suggests to limit EBRT to non-progressive patients after induction chemotherapy.