Multimodality treatment in unresectable cholangiocarcinoma

Mahdi Aghili; Hazhir Saberi; Mahtab Mojtahed Zadeh; Fatemeh Jafari; Mohammad-Mehdi Mehrabinejad; Habibollah Dashti; Pejman Saberi; Niloofar Ayoobi Yazdi

doi:10.5114/jcb.2020.94582

Multimodality treatment in unresectable cholangiocarcinoma

J Contemp Brachytherapy. 2020 Apr;12(2):131-138. doi: 10.5114/jcb.2020.94582. Epub 2020 Apr 30.

Authors

Mahdi Aghili¹, Hazhir Saberi², Mahtab Mojtahed Zadeh³, Fatemeh Jafari¹, Mohammad-Mehdi Mehrabinejad⁴, Habibollah Dashti⁵, Pejman Saberi⁶, Niloofar Ayoobi Yazdi²

Affiliations

¹ Radiation Oncology Research Center, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Radiology, Liver Transplantation Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Radiology Department, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
⁵ Liver Transplantation Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁶ University of Debrecen, Faculty of Debrecen, Hungary.

Abstract

Purpose: Cholangiocarcinomas (CCs) are rare and highly malignant cancers. Although there are different treatment protocols for treatment of cholangiocarcinoma, we aimed to investigate a survival rate of patients with unresectable extrahepatic CCs (ECCs) receiving multimodality therapeutic protocol (MTP) (biliary drainage + external beam radiotherapy [EBRT] + brachytherapy and systemic chemotherapy). Similarly, we aimed to identify a relationship between survival time and associated factors in treatment outcome.

Material and methods: This retrospective study was performed on patients with ECC, who were referred to our university hospital between 2012 and 2015, and their imaging were diagnosed as unresectable. Patients underwent MTP including internal-external drainage catheter (F10-12) with insertion under fluoroscopy guidance, EBRT with 25-28 fractions and concurrent chemotherapy using capecitabine (Xeloda) 825 mg/m² at the days of radiotherapy, followed by brachytherapy (BT) with iridium-192 (¹⁹²Ir) or cobalt-60 (⁶⁰Co) sources for 21 Gy in 3 consecutive days. Demographic variables, complications, laboratory tests, imaging findings, and survival time (OS - overall survival after diagnosis; CS - survival after catheter placement) were recorded.

Results: A total of 38 patients, with mean SD age = 58.08 (9.80) years, male = 22 (57.9%), were evaluated. According to Bismuth-Corlette classification, 15 (39.5%) were in stage IIIA, 5 (13.2%) were in stage IIIB, 10 (26.3%) were in stage IV, and 8 (21.2%) were undefined. Of those, 21 (55.3%), 15 (39.5%), and 17 (44.7%) were involved with liver parenchyma, great vessels, and regional lymph nodes, respectively. Mean SD of OS was 15.11 (8.10) months (median = 15; 95% CI: 13.25-16.69), and CS was 2-29 months (mean SD = 11.71 (7.29); median = 10; 95% CI: 10.05-13.37). Further analysis revealed a considerable decrease in OS and CS in those with an involvement of liver parenchyma, great vessels, regional lymph nodes, and Bismuth type IV.

Conclusions: Multimodality therapeutic approach in patients with inoperable ECCs could definitely improve their survival time and decrease complications. Survival time is significantly depending on tumor staging, gender, and involvement of liver parenchyma, great vessels, and regional lymph nodes.

Keywords: brachytherapy; chemotherapy; cholangiocarcinoma; drainage; radiotherapy; survival.