Gastrointestinal Cancer

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SU_13_2133 - Proton beam therapy for unresectable cholangiocarcinoma

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Proton beam therapy for unresectable cholangiocarcinoma
S. P. Hung, C. E. Hsieh, B. S. Huang, and J. H. Hong; Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose/Objective(s): To evaluate the treatment outcome and patterns of failure in patients with unresectable cholangiocarcinoma undergoing proton beam therapy (PBT).

Materials/Methods: We retrospectively analyzed 22 patients with pathologically confirmed cholangiocarcinoma who were treated with definitive PBT from November 2015 to August 2017. Four-dimensional computer tomography (4D-CT) with and without intravenous contrast-enhancement was acquired with 2.5 mm slide thickness. A clinical target volume expansion of 5-10 mm was used. The internal target volume was generated based on the 4D-CT images, and respiratory gaiting was adopted in patients with tumor motion >10 mm. Treatment-related toxicities were recorded according to Common Terminology Criteria for Adverse Event version 4.0 (CTCAE v4.0).

Results: The study included 11 male and 11 female participants, with a median age of 68 years (range, 46-88 years). Intrahepatic, perihilar and distal extrahepatic, and gallbladder tumors were recorded in 12 (54%), 7 (32%), 1 (5%) and 2 (9%), respectively. The median tumor dimension was 7.0 cm (range, 3.8-18.2 cm). Stage IV, III and II was documented in 15 (68%), 5 (23%) and 2 (9%) patients, respectively. Tumor vascular invasion was observed in 5 (23%) patients, and 19 (86%) patients demonstrated biliary tract obstruction. The median PBT dose was 72.6 cobalt gray equivalent (CGE) (range, 39.6-72.6 CGE). Gemcitabine-based concomitant chemotherapy was administered in 15 (68%) patients. After a median follow-up of 14.3 months, the 1-year overall survival rate was 75%. Fifteen (68%) patients developed disease progression. Among them, one (5%) patients experienced in-field local failure, whereas 4 (18%) patients developed intrahepatic out-field recurrence. Distant metastasis (N = 10, 45%) was the predominant form of treatment failure. The 1-year local control and progression-free survival rates were 100% and 42%, respectively. Among the 19 patients who presented obstructive jaundice, normalization of total bilirubin level was recorded in 14 (74%) patients after PBT with or without biliary drainage. Grade 3 dermatitis and grade 4 duodenal ulcer occurred in 2 (9%) and 2 (9%) patients, respectively.

Conclusion: PBT could lead to an excellent local control probability, sustainable relief of biliary tract obstruction and a favorable survival outcome in patients with unresectable cholangiocarcinoma. However, distant recurrence remains the primary reason of failure after PBT.

Author Disclosure: S. Hung: None. C. Hsieh: None.

Sheng-Ping Hung, MD

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