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Radiation therapy in cholangiocellular carcinomas.

Thomas B Brunner1, Thomas Seufferlein2

  • 1Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, Freiburg, Germany; German Cancer Consortium (DKTK), Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.

Best Practice & Research. Clinical Gastroenterology
|September 21, 2016
PubMed
Summary

Adjuvant chemoradiotherapy is a key treatment for biliary tract cancers like cholangiocarcinoma, with stereotactic body radiotherapy (SBRT) emerging as a powerful alternative for definitive treatment, improving local control.

Keywords:
AdjuvantChemoradiothearpyChemotherapyCholangiocarcinomaDefinitive

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Surgical Oncology

Background:

  • Cholangiocarcinoma (CCA) presents therapeutic challenges due to its varied locations within the biliary tract.
  • Local relapse post-surgery is a significant clinical problem in CCA management.
  • Adjuvant chemoradiotherapy has been investigated to improve outcomes.

Purpose of the Study:

  • To review the current evidence for adjuvant and definitive treatment strategies in cholangiocarcinoma.
  • To highlight the role of chemoradiotherapy and stereotactic body radiotherapy (SBRT) in managing CCA.
  • To identify areas for future clinical trial development.

Main Methods:

  • Review of clinical trial data, focusing on the SWOG-S0809 trial for extrahepatic CCA and gallbladder cancer.
  • Comparison of conventionally fractionated radiotherapy with SBRT for definitive treatment.
  • Evaluation of sequential chemotherapy combinations.

Main Results:

  • The SWOG-S0809 regimen represents a high level of evidence for adjuvant chemoradiotherapy in specific CCA subtypes.
  • Stereotactic body radiotherapy (SBRT) offers an alternative to chemoradiotherapy for definitive treatment, enhancing local control through higher radiation doses.
  • Sequential chemotherapy regimens are commonly used.

Conclusions:

  • While surgery is primary, adjuvant chemoradiotherapy and SBRT are crucial in improving outcomes for cholangiocarcinoma.
  • SBRT shows promise as a definitive treatment option, offering improved local tumor control.
  • Cholangiocarcinoma remains an orphan disease, necessitating further clinical trials to strengthen the evidence base.