Abstract
Purpose
To evaluate the role of radiotherapy for patients with resected intrahepatic cholangiocarcinoma with concurrent macroscopic abdominal lymph node metastases.
Methods
We identified 90 patients with resected intrahepatic cholangiocarcinoma and concurrent regional lymph node metastases treated between 1999 and 2008, thereinto 24 patients received local limited external beam radiotherapy (classified as the radiotherapy group) with a median total dose of 50 Gy (range 34–60 Gy) in fractions of 2 Gy five times a week. The remaining 66 patients did not receive external beam radiotherapy (classified as the non-radiotherapy group). We studied survival and tumor response to radiotherapy, demonstrated by symptoms and results of imaging, by Kaplan–Meier method and Cox analysis.
Results
After radiotherapy, lymph nodes showed partial response in nine patients (37.5%) and complete response in nine patients (37.5%). Median survival was 19.1 months in the radiotherapy group and 9.5 months in the non-radiotherapy group (P = 0.011). Multivariate analysis showed that increasing age, multiple intrahepatic primary tumors, higher level of CA19-9, and non-radiotherapy group were related to a poorer prognosis. The most common cause of death was intrahepatic recurrence, and death resulting from lymph node-related complications was similar between the two groups.
Conclusions
External beam radiotherapy seems to improve the prognosis of patients with resected intrahepatic cholangiocarcinoma and concurrent macroscopic lymph node metastases.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Asakura H, Ohtsuka M, Ito H, Kimura F, Ambiru S, Shimizu H, Togawa A, Yoshidome H, Kato A, Miyazaki M (2005) Long-term survival after extended surgical resection of intrahepatic cholangiocarcinoma with extensive lymph node metastasis. Hepatogastroenterology 52:722–724
Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, Cappellani A, Malfermoni G, Iacono C (2009) Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 33:1247–1254
Hawkins WG, DeMatteo RP, Cohen MS, Jarnagin WR, Fong Y, D’Angelica M, Gonen M, Blumgart LH (2005) Caudate hepatectomy for cancer: a single institution experience with 150 patients. J Am Coll Surg 200:345–352
Mosconi S, Beretta GD, Labianca R, Zampino MG, Gatta G, Heinemann V (2009) Cholangiocarcinoma. Crit Rev Oncol Hematol 69:259–270
Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H, Kudo T, Todo S (2005) Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg 29:728–733
Nakagohri T, Asano T, Kinoshita H, Kenmochi T, Urashima T, Miura F, Ochiai T (2003) Aggressive surgical resection for hilar-invasive and peripheral intrahepatic cholangiocarcinoma. World J Surg 27:289–293
Nozaki Y, Yamamoto M, Ikai I, Yamamoto Y, Ozaki N, Fujii H, Nagahori K, Matsumoto Y, Yamaoka Y (1998) Reconsideration of the lymph node metastasis pattern (N factor) from intrahepatic cholangiocarcinoma using the International Union Against Cancer TNM staging system for primary liver carcinoma. Cancer 83:1923–1929
Peycru T, Hardwigsen J, Grégoire E, Barbier L, Richa H, Campan P, Le Treut YP (2009) Radical surgery in intrahepatic cholangiocarcinoma. Gastroenterol Clin Biol 33:187–193 (in French)
Popescu I, Ciurea S, Romanescu D, Boros M (2008) Isolated resection of the caudate lobe: indications, technique and results. Hepatogastroenterology 55:831–835
Shaib YH, Davila JA, Henderson L, McGlynn KA, El-Serag HB (2007) Endoscopic and surgical therapy for intrahepatic cholangiocarcinoma in the United States. A population-based study. J Clin Gastroenterol 41:911–917
Shimada M, Yamashita Y, Aishima S, Shirabe K, Takenaka K, Sugimachi K (2001) Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma. Br J Surg 88:1463–1466
Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Ojima H (2007) Clinical impact of the surgical margin status in hepatectomy for solitary mass-forming type intrahepatic cholangiocarcinoma without lymph node metastases. J Surg Oncol 96:160–165
Shimada K, Sano T, Nara S, Esaki M, Sakamoto Y, Kosuge T, Ojima H (2009) Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery 145:411–416
Shinohara ET, Mitra N, Guo M, Metz JM (2008) Radiation therapy is associated with improved survival in the adjuvant and definitive treatment of intrahepatic cholangiocarcinoma. Int J Radiat Oncology Biol Phys 72:1495–1501
Sun HC, Zhuang PY, Qin LX, Ye QH, Wang L, Ren N, Zhang JB, Qian YB, Lu L, Fan J, Tang ZY (2007) Incidence and prognostic values of lymph node metastasis in operable hepatocellular carcinoma and evaluation of routine complete lymphadenectomy. J Surg Oncol 96:37–45
Tajima Y, Kuroki T, Fukuda K, Tsuneoka N, Furui J, Kanematsu T (2004) An intraductal papillary component is associated with prolonged survival after hepatic resection for intrahepatic cholangiocarcinoma. Br J Surg 91:99–104
Trotti A, Byhardt R, Stetz J, Gwede C, Corn B, Fu K, Gunderson L, McCormick B, Morrisintegral M, Rich T, Shipley W, Curran W (2000) Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys 47:13–47
Uenishi T, Hirohashi K, Kubo S, Yamamoto T, Yamazaki O (2001) Kinoshita H (2001) Clinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma. Br J Surg 88:969–974
Uenishi T, Kubo S, Yamazaki O, Yamada T, Sasaki Y, Nagano H, Monden M (2008) Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases. J Hepatobiliary Pancreat Surg 15:417–422
Yamamoto M, Takasaki K, Yoshikawa T (1998) Lymph node metastasis in intrahepatic cholangiocarcinoma. Jpn J Clin Oncol 29:147–150
Yamashita Y, Taketomi A, Morita K, Fukuhara T, Ueda S, Sanefuji K, Iguchi T, Kayashima H, Sugimachi K, Maehara Y (2008) The impact of surgical treatment and poor prognostic factors for patients with intrahepatic cholangiocarcinoma: retrospective analysis of 60 patients. Anticancer Res 28:2353–2359
Yedibela S, Demir R, Zhang W, Meyer T, Hohenberger W, Schönleben F (2009) Surgical treatment of mass-forming intrahepatic cholangiocarcinoma: an 11-year western single-center experience in 107 patients. Ann Surg Oncol 16:404–412
Zeng ZC, Tang ZY, Fan J, Qin LX, Ye SL, Zhou J, Sun HC, Wang BL, Wang JH (2005) Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factors from 125 patients. Int J Radiat Oncol Biol Phys 63:1067–1076
Zeng ZC, Tang ZY, Fan J, Zhou J, Qin LX, Ye SL, Sun HC, Wang BL, Li D, Wang JH, Zeng MS, Guo W, Tan YS (2006) Consideration of the role of radiotherapy for unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 75 patients. Cancer J 14:113–122
Zhou XD, Tang ZY, Fan J, Zhou J, Wu ZQ, Qin LX, Ma ZC, Sun HC, Qiu SJ, Yu Y, Ren N, Ye QH, Wang L, Ye SL (2009) Intrahepatic cholangiocarcinoma: report of 272 patients compared with 5,829 patients with hepatocellular carcinoma. J Cancer Res Clin Oncol 135:1073–1080
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jiang, W., Zeng, ZC., Tang, ZY. et al. Benefit of radiotherapy for 90 patients with resected intrahepatic cholangiocarcinoma and concurrent lymph node metastases. J Cancer Res Clin Oncol 136, 1323–1331 (2010). https://doi.org/10.1007/s00432-010-0783-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-010-0783-1