Prognostic Factors & Patterns of Locoregional Failure After Surgical Resection..

Prognostic Factors and Patterns of Locoregional Failure After Surgical Resection in Patients With Cholangiocarcinoma Without Adjuvant Radiation Therapy: Optimal Field Design for Adjuvant Radiation Therapy.

1. Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):805-811. doi:
10.1016/j.ijrobp.2017.06.2467. Epub 2017 Jul 5.

https://www.ncbi.nlm.nih.gov/pubmed/29063849

Ghiassi-Nejad Z, Tarchi P, Moshier E, Ru M, Tabrizian P, Schwartz
M, Buckstein M.

PURPOSE: To identify prognostic factors and patterns of local failure in patients
with cholangiocarcinoma (CCA), after surgical resection in the absence of
adjuvant radiation, for optimal definition of target volumes encompassing the
majority of local recurrences.
METHODS AND MATERIALS: A chart review was performed in patients who underwent
resection for primary CCA (intrahepatic, hilar, and distal) between 1999 and
2014. Local failure was defined as recurrence in a theoretical reasonable
postoperative radiation volume. This includes the cut surface of liver, biliary
anastomosis, hilum, portal nodes, celiac nodes, peri-pancreatic nodes,
gastro-hepatic nodes, and retroperitoneal nodes. Patients who received adjuvant
radiation were excluded.
RESULTS: A total of 189 patients underwent surgical resection for CCA, of whom
145 patients had sufficient follow-up. Median follow-up was 41.6 months (95%
confidence interval 35.4-48.7 months). Of the 145 cases, 102 were intrahepatic
and 43 were hilar/distal CCA. Adjuvant chemotherapy was given in 38 cases (26%),
of which 20 (54%) were gemcitabine-based. Eighty-six patients (59%) had a
documented recurrence, of whom 44 (51%) had a locoregional component. Among
patients who had a recurrence, 23 (27%) had a recurrence at the biliary
anastomosis and/or cut liver surface. Twenty-eight patients (32.6%) had a
recurrence in the regional lymph nodes, most prevalent in the portal (16.3%) and
retroperitoneal (17.4%) lymph nodes. Univariable analysis identified tumor size,
any vascular invasion, presence of satellites, stage/nodal status, and receipt of
chemotherapy as significant prognostic factors of overall recurrence among
intrahepatic patients. Presence of satellites, and stage 3/Nx status remained
statistically significant in multivariable modeling.
CONCLUSIONS: The areas at highest risk for locoregional recurrence after surgical
resection for primary CCA are the biliary anastomosis/cut liver surface, portal
lymph nodes, and retroperitoneal lymph nodes. Although these results need to be
validated, adjuvant radiation should possibly cover these areas to maximize
locoregional control.

Copyright © 2017 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ijrobp.2017.06.2467
PMID: 29063849