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

Publication date: Available online 5 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Zahra Ghiassi-Nejad, Paola Tarchi, Erin Moshier, Meng Ru, Parissa Tabrizian, Myron Schwartz, Michael Buckstein
PurposeTo identify prognostic factors and patterns of local failure in patients with cholangiocarcinoma, following surgical resection in the absence of adjuvant radiation, for optimal definition of target volumes encompassing the majority of local recurrences.Methods and MaterialsA 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 post-operative 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.Results189 patients underwent surgical resection for CCA, of which 145 patients had sufficient follow up. Median follow up was 41.6 months (95% CI: 35.4-48.7). 102 cases were intrahepatic, and 43 were hilar/distal CCA. Adjuvant chemotherapy was given in 38 (26%) of cases, of which 20 (54%) were gemcitabine based. Eighty six patients (59%) had a documented recurrence, of which 44 (51%) had a locoregional component. Among patients that had a recurrence, 23 (27%) had a recurrence at the biliary anastomosis and/or cut liver surface. Twenty eight (32.6%) patients 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 were significant prognostic factors of overall recurrence among IHC patients. Presence of satellites, and stage 3/Nx status remained statistically significant in multivariable modeling.ConclusionsThe areas at highest risk for locoregional recurrence following surgical resection are the biliary anastomosis/cut liver surface, portal lymph nodes, and retroperitoneal lymph nodes. While these results need to be validated, adjuvant radiation should possibly cover these areas to maximize locoregional control.

Teaser

Locoergional recurrences following surgical resection for cholangiocarcinoma (CCA) cause significant morbidity and mortality. This retrospective analysis explores risk factors for local failures and maps locoregional recurrences in patients who underwent surgery without adjuvant radiation. The recurrence map provides valuable information for delineating optimal planning target volumes for adjuvant radiation.


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