Table 5.
Studies examining external body radiotherapy (EBRT) for intrahepatic cholangiocarcinoma.
| EBRT | |||||
|---|---|---|---|---|---|
| Author (Year) | Study Type and Time Period | Patient Population | Technique | Outcomes | Complications |
| Single Cohorts | |||||
| Smart (2020) [81] | Retrospective Study 2008–2018 |
N = 66 Median 76 y/o Unresectable or locally recurrent ICC Tumor size 2.5–16 cm |
Hypofractionated proton or photon EBRT Median RT dose = 58.05 Gy |
2 yr LC = 84% 2 yr OS = 58% Median OS = 25 mo |
Grade 3+: 11% |
| Tao (2016) [84] | Retrospective Study 2002–2014 |
EBRT + ChT N = 70 EBRT alone N = 9 Unresectable ICC, stage I-IV Tumor size 2.2–17 cm |
EBRT Median RT dose = 58.05 Gy Median BED = 80.5 Gy |
Median OS = 30 mo 3 yr OS: BED > 80.5 Gy = 73% BED < 80.5 Gy = 38% |
6.3% hospitalized within 90 days of EBRT |
| Comparative Cohorts | |||||
| Kolarich (2018) [85] | Retrospective Study NCDB 2004–2015 |
N = 2222 EBRT, RFA, RI, and no local therapy Nonsurgical patients, stage I-IV ICC |
EBRT, RFA, or RI vs. no local therapy | Stage I median OS: RFA = 2.1 yr, EBRT = 1.7 yr, No local therapy = 0.7 yr Stage II median OS: ND Stage III median OS: EBRT = 0.9 yr, RI = 1.2 yr, No local therapy = 0.6 yr Stage IV median OS: RI = 0.9 yr, No local therapy = 0.3 yr |
|
| Shao (2018) [80] | Retrospective Cohort Study SEER 1973–2013 |
Palliative EBRT N = 847 No EBRT = 3180 Median 64 y/o Palliative EBRT for unresectable ICC Included tumors > 5 cm |
Palliative EBRT vs. no EBRT | OS: EBRT > none (HR = 0.844, p = 0.00228) CSS: EBRT > none (HR = 0.8563, p = 0.0037) |
|
| Hammad (2016) [86] | Retrospective Cohort Study NCDB 1998–2013 |
Total N = 2897 EBRT N = 525 Median 65 y/o Adjuvant EBRT Included tumors > 5 cm |
SR + EBRT vs. SR alone | Median OS R1/R2 LN (-) patients: SR + EBRT = 39.5 mo SR alone = 21.1 mo p = 0.052 |
|
| Jackson (2016) [87] | Retrospective Study NCDB 2001–2011 |
Total N = 1636 Median 63 y/o Unresectable, localized ICC |
EBRT + ChT vs. ChT alone | 2 yr OS: EBRT + ChT = 25.8% ChT alone = 20% p = 0.001 |
|
| Chen (2010) [82] | Retrospective Cohort Study 12/1998–12/2008 |
Palliative EBRT N = 35 No EBRT N = 49 Palliative EBRT for unresectable ICC, stage I-IV Included tumors > 10 cm |
EBRT vs. no EBRT Median RT dose = 50 Gy |
Median OS: EBRT = 9.5 mo No EBRT = 5.1 mo 1, 2 yr OS: EBRT = 38.5%, 9.6% No EBRT = 16.4%, 4.9% |
Grade 3: 11.4% 1 RILD resulting in mortality |
| Jiang (2010) [88] | Retrospective Cohort Study 01/1999–12/2008 |
EBRT N = 24 No EBRT N = 66 Resected ICC with LN metastasis Included tumors > 10 cm |
EBRT vs. no EBRT Median RT dose = 50 Gy |
Median OS: EBRT = 19.1 mo No EBRT = 9.5 mo |
Grade 3: 12.5% |
| Shinohara (2008) [89] | Retrospective Cohort Study SEER 1988–2003 |
Total N = 3839 Median 73 y/o Adjuvant and definitive EBRT |
SR + EBRT or BI vs. SR alone vs. EBRT or BI alone vs. no treatment | Median OS: SR + EBRT/BI = 11 mo SR alone = 6 mo EBRT/BI alone = 7 mo No treatment = 3 mo |
|
| Zeng (2006) [83] | Retrospective Cohort Study 01/1998–12/2004 |
EBRT N = 38 No EBRT N = 37 Unresectable ICC and post-op EBRT for LN (+) metastasis Included tumors > 10 cm |
EBRT vs. no EBRT Median RT dose = 50 Gy |
1, 2 yr OS: EBRT = 50.1%, 11.8% No EBRT = 24.8%, 5.5% p = 0.005 |
Grade 3: 7.9% |
Abbreviations: BED = biologic equivalent dose; BI = brachytherapy implants; ChT = chemotherapy; CSS = cancer-specific survival; EBRT = external body radiotherapy; ICC = intrahepatic cholangiocarcinoma; LC = local control; LN = lymph node; mo = month; NCDB = National Cancer Database; ND = no difference; OS = overall survival; RFA = radiofrequency ablation; RI = radioactive implant; RILD = radiation-induced liver disease; RT = radiation therapy; R1/R2 = positive margins after surgical resection; SEER = The Surveillance, Epidemiology, and End Results database; SR = surgical resection; s/p = status-post; yr = year; y/o = years old.