Abstract
Purpose
Non-surgical treatment including stereotactic body radiation therapy (SBRT) have been used practically as alternative modalities for unresectable or recurrent cholangiocarcinoma (CC). We performed a systematic review and meta-analysis to examine the efficacy of SBRT for such patients.
Methods
Embase, PubMed, MEDLINE, and Cochrane library databases were searched systematically until October 2017. Primary endpoint was 1‑year local control (LC) rate; 1‑year overall survival (OS), response rates, and grade ≥3 toxicities were assessed as secondary endpoints.
Results
Eleven studies (226 patients) were included. The prescribed median SBRT dose was 45 (range 30–55) Gy in 3–5 fractions. The pooled 1‑year LC rate was 81.8% (95% confidence interval [CI] 69.4–89.9%) in the studies using an equivalent dose in 2 Gy per fraction (EQD2) ≥71.3 Gy2 and 74.7% (95% CI 57.1–86.7%) in the studies using an EQD2 <71.3 Gy2. The median OS was 13.6 (range 10–35.5) months. The pooled 1‑year OS rate was 53.8% (95% CI 44.9–62.5%) and the pooled 1‑year LC rate was 78.6% (95% CI 69.0–85.8%). Most common toxicity was duodenal ulcer and gastric ulcer in available studies, with the acute incidence of grade ≥3 of less than 10% and the late incidence of 10–20%.
Conclusions
SBRT was a feasible treatment option with respect to achieving a high LC for unresectable or recurrent CC. Gastrointestinal toxicity is acceptable, but remains an obstacle related to dose escalation.
Zusammenfassung
Hintergrund
Die nichtoperative Behandlung einschließlich der stereotaktischen Strahlentherapie (SBRT) wurde praktisch als alternatives Verfahren für das inoperable oder rezidivierende Cholangiokarzinom (CC) eingesetzt. Wir führten eine systematische Überprüfung und Metaanalyse durch, um die Wirksamkeit der SBRT bei solchen Patienten zu untersuchen.
Methoden
Die Embase‑, PubMed‑, Medline- und Cochrane-Bibliotheksdatenbanken wurden bis Oktober 2017 systematisch durchsucht. Primärer Endpunkt war die 1‑Jahres-Rate der lokalen Kontrolle (LC). Das 1‑Jahres-Gesamtüberleben (OS), die Ansprechraten und Toxizitätsgrade >3 wurden als sekundäre Endpunkte bewertet.
Ergebnisse
Elf Studien (226 Patienten) wurden eingeschlossen. Die vorgeschriebene mediane SBRT-Dosis betrug 45 (Bereich 30–55) Gy in 3–5 Fraktionen. Die gepoolte 1‑Jahres-LC-Rate betrug 81,8 % (95 %-Konfidenzintervall [KI] 69,4–89,9 %) in den Studien mit einer äquivalenten Dosis in 2 Gy pro Fraktion (EQD2) ≥71,3 Gy2 und 74,7 % (95 %-KI 57,1–86,7 %) in den Studien mit einer EQD2 <71,3 Gy2. Das mediane OS betrug 13,6 (Bereich 10–35,5) Monate. Die gepoolte 1‑Jahres-OS-Rate betrug 53,8 % (95 %-KI 44,9–62,5 %) und die gepoolte 1‑Jahres-LC-Rate 78,6 % (95 %-KI 69,0–85,8 %). Die häufigsten Toxizitäten waren Ulcus duodeni und Ulcus ventriculi in den verfügbaren Studien mit einer akuten Inzidenz von Grad ≥3 unter 10 % und einer späten Inzidenz von 10 bis 20 %.
Schlussfolgerungen
Die SBRT war eine machbare Behandlungsoption in Bezug auf die Erreichung einer hohen LC bei inoperablen oder rezidivierenden CC. Die gastrointestinale Toxizität ist akzeptabel, bleibt jedoch ein Hindernis im Zusammenhang mit der Dosiseskalation.
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J. Lee, W.S. Yoon, W.S. Koom and C.H. Rim declare that they have no competing interests.
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Lee, J., Yoon, W.S., Koom, W.S. et al. Efficacy of stereotactic body radiotherapy for unresectable or recurrent cholangiocarcinoma: a meta-analysis and systematic review. Strahlenther Onkol 195, 93–102 (2019). https://doi.org/10.1007/s00066-018-1367-2
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DOI: https://doi.org/10.1007/s00066-018-1367-2
Keywords
- Cholangiocarcinoma
- Stereotactic body radiotherapy
- Efficacy
- Meta-analysis
- Stereotactic ablative body radiotherapy