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J Korean Soc Ther Radiol Oncol > Volume 27(4); 2009 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2009;27(4): 181-188. doi: https://doi.org/10.3857/jkstro.2009.27.4.181
The Results of Postoperative Radiation Therapy for Perihilar Cholangiocarcinoma
Yu Sun Lee, Jae Won Park, Jin Hong Park, Eun Kyung Choi, Seung Do Ahn, Sang Wook Lee, Si Yeol Song, Sung Gyu Lee, Shin Hwang, Young Joo Lee, Kwang Min Park, Ki Hun Kim, Chul Soo Ahn, Deok Bog Moon, Heung Moon Chang, Min Hee Ryu, Tae Won Kim, Jae Lyun Lee, Jong Hoon Kim
1Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jhkim2@amc.seouol.kr
2Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
The aim of this study was to evaluate the results of postoperative radiotherapy in a case of perihilar cholagiocarcinoma by analyzing overall survival rate, patterns of failure, prognostic factors for overall survival, and toxicity.
Between January 1998 and March 2008, 38 patients with perihilar cholangiocarcinoma underwent a surgical resection and adjuvant radiotherapy. The median patient age was 59 years (range, 28 to 72 years), which included 23 men and 15 women. The extent of surgery was complete resection in 9 patients, microscopically positive margins in 25 patients, and a subtotal resection in 4 patients. The tumor bed and regional lymphatics initially received 45 Gy or 50 Gy, but was subsequently boosted to a total dose of 59.4 Gy or 60 Gy in incompletely resected patients. The median radiotherapy dose was 59.4 Gy. Concurrent chemotherapy was administered in 30 patients. The median follow-up period was 14 months (range, 6 to 45 months).
The 3-year overall survival and 3-year progression free survival rates were 30% and 8%, respectively. The median survival time was 28 months. A multivariate analysis showed that differentiation was the only significant factor for overall survival. The 3-year overall survival was 34% in R0 patients and 20% in R1 patients. No statistically significant differences in survival were found between the 2 groups (p=0.3067). The first site of failure was local in 18 patients (47%). No patient experienced grade 3 or higher acute toxicity and duodenal bleeding developed in 2 patients.
Our results suggest that adjuvant RT might be a significant factor in patients with a positive margin following a radical resection. However, there was still a high locoregional recurrence rate following surgery and postoperative radiotherapy. Further study is necessary to enhance the effect of the adjuvant radiotherapy.
Key Words: Perihilar cholangiocarcinoma, Operation, Radiation therapy
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