Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026
Tumor-related local complications as a major contributor to mortality after definitive radiotherapy for unresectable extrahepatic bile duct cancer.
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Yoo Ye Jin, Park Jin-Hong
Аннотация
PURPOSE: This study investigated oncologic outcomes and causes of death after radiotherapy in patients with unresectable extrahepatic bile duct cancer.
METHODS: We retrospectively analyzed 74 patients with localized unresectable or inoperable extrahepatic bile duct cancer treated with conventionally fractionated radiotherapy between September 2005 and February 2019. Fifty-five patients (74.3%) underwent three-dimensional conformal radiotherapy, and 19 patients (25.7%) received intensity-modulated radiotherapy. Induction chemotherapy was administered in 18 patients and 57 patients received concurrent chemotherapy.
RESULTS: Among all patients, 90.5% (67/74) had perihilar bile duct cancer, and the median radiotherapy dose was 54.0 Gy. With a median follow-up of 16.2 months, the median progression-free survival and overall survival were 11.5 and 18.3 months, respectively. Distant metastasis was the predominant first failure pattern (52.7%), followed by locoregional progression (20.3%). The 1- and 2-year freedom from local progression rates were 86.3% and 36.2%, respectively. Cholangitis, liver failure, and tumor bleeding accounted for 26 of 65 deaths, corresponding to at least 40.0% of all deaths. Radiotherapy dose above 54 Gy was not significantly associated with freedom from local progression, progression-free survival, or overall survival. No patients experienced grade ≥ 3 acute gastrointestinal toxicity, whereas grade ≥ 3 late toxicities occurred in 8.1%.
CONCLUSION: Definitive radiotherapy provided favorable local control with acceptable toxicity in unresectable extrahepatic bile duct cancer. Although distant metastasis was the predominant failure pattern, local complications accounted for at least 40% of deaths, supporting continued efforts to optimize local treatment alongside emerging systemic therapies.
METHODS: We retrospectively analyzed 74 patients with localized unresectable or inoperable extrahepatic bile duct cancer treated with conventionally fractionated radiotherapy between September 2005 and February 2019. Fifty-five patients (74.3%) underwent three-dimensional conformal radiotherapy, and 19 patients (25.7%) received intensity-modulated radiotherapy. Induction chemotherapy was administered in 18 patients and 57 patients received concurrent chemotherapy.
RESULTS: Among all patients, 90.5% (67/74) had perihilar bile duct cancer, and the median radiotherapy dose was 54.0 Gy. With a median follow-up of 16.2 months, the median progression-free survival and overall survival were 11.5 and 18.3 months, respectively. Distant metastasis was the predominant first failure pattern (52.7%), followed by locoregional progression (20.3%). The 1- and 2-year freedom from local progression rates were 86.3% and 36.2%, respectively. Cholangitis, liver failure, and tumor bleeding accounted for 26 of 65 deaths, corresponding to at least 40.0% of all deaths. Radiotherapy dose above 54 Gy was not significantly associated with freedom from local progression, progression-free survival, or overall survival. No patients experienced grade ≥ 3 acute gastrointestinal toxicity, whereas grade ≥ 3 late toxicities occurred in 8.1%.
CONCLUSION: Definitive radiotherapy provided favorable local control with acceptable toxicity in unresectable extrahepatic bile duct cancer. Although distant metastasis was the predominant failure pattern, local complications accounted for at least 40% of deaths, supporting continued efforts to optimize local treatment alongside emerging systemic therapies.