Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases
Introduction: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the r...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2023-03-01
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| Series: | Liver Cancer |
| Online Access: | https://www.karger.com/Article/FullText/530134 |
| _version_ | 1827967956830650368 |
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| author | Brian De Rituraj Upadhyay Kaiping Liao Tiffany Kumala Christopher Shi Grace Dodoo Joseph Abi Jaoude Kelsey L. Corrigan Gohar S. Manzar Kathryn E. Marqueen Vincent Bernard Sunyoung S Lee Kanwal P.S. Raghav Jean-Nicolas Vauthey Ching-Wei Tzeng Hop S. Tran Cao Grace Lee Jennifer Wo Theodore S Hong Christopher H Crane Bruce D. Minsky Grace L. Smith Emma B. Holliday Cullen M. Taniguchi Albert C. Koong Prajnan Das Milind Javle Ethan B. Ludmir Eugene Koay |
| author_facet | Brian De Rituraj Upadhyay Kaiping Liao Tiffany Kumala Christopher Shi Grace Dodoo Joseph Abi Jaoude Kelsey L. Corrigan Gohar S. Manzar Kathryn E. Marqueen Vincent Bernard Sunyoung S Lee Kanwal P.S. Raghav Jean-Nicolas Vauthey Ching-Wei Tzeng Hop S. Tran Cao Grace Lee Jennifer Wo Theodore S Hong Christopher H Crane Bruce D. Minsky Grace L. Smith Emma B. Holliday Cullen M. Taniguchi Albert C. Koong Prajnan Das Milind Javle Ethan B. Ludmir Eugene Koay |
| author_sort | Brian De |
| collection | DOAJ |
| description | Introduction: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT.
Methods: We reviewed ICC patients found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose (BED10) was 98 Gy (interquartile range [IQR] 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazards modeling.
Results: We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; P=0.001). On multivariable propensity-score matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; P=0.005) and receipt of L-RT (HR 0.40; P=0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; P<0.001).
Discussion/Conclusion: For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS vs. those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted. |
| first_indexed | 2024-04-09T18:14:52Z |
| format | Article |
| id | doaj.art-b4a232d77a5c466f98d5d1a17a3c4c2e |
| institution | Directory Open Access Journal |
| issn | 2235-1795 1664-5553 |
| language | English |
| last_indexed | 2024-04-09T18:14:52Z |
| publishDate | 2023-03-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Liver Cancer |
| spelling | doaj.art-b4a232d77a5c466f98d5d1a17a3c4c2e2023-04-13T08:16:40ZengKarger PublishersLiver Cancer2235-17951664-55532023-03-011110.1159/000530134530134Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastasesBrian Dehttps://orcid.org/0000-0003-3468-3359Rituraj UpadhyayKaiping LiaoTiffany KumalaChristopher Shihttps://orcid.org/0000-0002-9222-8365Grace DodooJoseph Abi Jaoudehttps://orcid.org/0000-0002-2283-4765Kelsey L. CorriganGohar S. Manzarhttps://orcid.org/0000-0003-0331-7102Kathryn E. MarqueenVincent Bernardhttps://orcid.org/0000-0003-1555-608XSunyoung S LeeKanwal P.S. RaghavJean-Nicolas Vautheyhttps://orcid.org/0000-0003-4921-5427Ching-Wei TzengHop S. Tran Caohttps://orcid.org/0000-0001-8612-8272Grace LeeJennifer Wohttps://orcid.org/0000-0001-9872-5912Theodore S HongChristopher H CraneBruce D. MinskyGrace L. Smithhttps://orcid.org/0000-0002-3171-2911Emma B. HollidayCullen M. TaniguchiAlbert C. KoongPrajnan DasMilind JavleEthan B. Ludmirhttps://orcid.org/0000-0002-5472-5344Eugene Koayhttps://orcid.org/0000-0001-7675-3461Introduction: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT. Methods: We reviewed ICC patients found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose (BED10) was 98 Gy (interquartile range [IQR] 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazards modeling. Results: We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; P=0.001). On multivariable propensity-score matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; P=0.005) and receipt of L-RT (HR 0.40; P=0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; P<0.001). Discussion/Conclusion: For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS vs. those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted.https://www.karger.com/Article/FullText/530134 |
| spellingShingle | Brian De Rituraj Upadhyay Kaiping Liao Tiffany Kumala Christopher Shi Grace Dodoo Joseph Abi Jaoude Kelsey L. Corrigan Gohar S. Manzar Kathryn E. Marqueen Vincent Bernard Sunyoung S Lee Kanwal P.S. Raghav Jean-Nicolas Vauthey Ching-Wei Tzeng Hop S. Tran Cao Grace Lee Jennifer Wo Theodore S Hong Christopher H Crane Bruce D. Minsky Grace L. Smith Emma B. Holliday Cullen M. Taniguchi Albert C. Koong Prajnan Das Milind Javle Ethan B. Ludmir Eugene Koay Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases Liver Cancer |
| title | Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases |
| title_full | Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases |
| title_fullStr | Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases |
| title_full_unstemmed | Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases |
| title_short | Definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases |
| title_sort | definitive liver radiotherapy for intrahepatic cholangiocarcinoma with extrahepatic metastases |
| url | https://www.karger.com/Article/FullText/530134 |
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