Chemoradiation of locally advanced biliary cancer. A systematic review.
PO-1360
Abstract
Chemoradiation of locally advanced biliary cancer. A systematic review.
Authors: Silvia Bisello1, Claudio Malizia2, Anna Benini1, Filippo Mammini1, Viola Laghi1, Silvia Paolinelli1, Alessandra Guido3, Andrea Galuppi3, Alessandra Arcelli3, Martina Ferioli1, Milly Buwenge1, Gabriella Macchia4, Francesco Deodato4, Savino Cilla5, Silvia Cammelli1, Alessio Giuseppe Morganti1
1Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy; 3Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 4Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy; 5Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
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Purpose or Objective
Biliary tract cancers (BTC) are rare and aggressive neoplasms. Based on international guidelines the management of locally advanced or unresectable BTC is based on chemotherapy (CHT) alone. Concurrent chemoradiation (CRT) may represent an alternative treatment. Aim of this study is to review the current evidence on “modern” CRT for primary or recurrent unresectable BTC.
Material and Methods
Papers were searched on Pubmed, Scopus, and Cochrane Library. Prospective or retrospective trials reporting outcomes after concurrent CRT of unresectable non-metastatic, primary or recurrent BTC were included. Only English-written papers, published from January 2010 to June 2022 were considered.
Results
Seventeen papers were included in the analysis, with a total of 1961 patients. Eleven papers included only patients with primary unresectable BTC, while two papers enrolled patients with isolated local recurrences. Four papers considered both settings. Twelve papers included patients with intrahepatic, extrahepatic, and hilar BTC, or gallbladder cancer. A median dose of 50.4 Gy (range 45.0-72.6 Gy) was delivered with conventional fractionation. Concurrent CHT was mainly based on 5-Fluorouracil or Gemcitabine.
Median overall survival (OS) and progression-free survival were 13.5 and 8.2 months, respectively. One- and two-year OS were 63.1 and 29.4%, respectively. Grade ≥3 acute gastrointestinal toxicity ranged from 5.6 to 22.2 % (median: 10.9%), and grade ≥3 haematological toxicity ranged from 1.6 to 50.0% (median: 21.7%).
Conclusion
CRT is an effective alternative to standard CHT in patients with locally advanced BTC, due to almost comparable OS and PFS and with an acceptable toxicity profile. Prospective trials are needed to confirm these results.