Clinical outcomes for hilar and extrahepatic cholangiocarcinoma with adjuvant, definitive, or liver transplant-based neoadjuvant chemoradiotherapy strategies: a single-center experience

Brady S. Laughlin, Molly M. Petersen, Nathan Y. Yu, Justin D. Anderson, William G. Rule, Mitesh J. Borad, Bashar A. Aqel, Mohamad B. Sonbol, Amit K. Mathur, Adyr Moss, Tanios S. Bekaii-Saab, Daniel H. Ahn, Todd A. DeWees, Terence T. Sio, Jonathan B. Ashman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We report our experience with 3 strategies for treating hilar and extrahepatic cholangiocarcinoma (CCA) including chemoradiotherapy: neoadjuvant chemoradiotherapy (nCRT) and orthotopic liver transplant, surgical resection and adjuvant chemoradiotherapy (aCRT), and definitive chemoradiotherapy (dCRT). Methods: We included patients treated from 1998 through 2019. Kaplan-Meier estimates, log-rank testing, and univariate/multivariate Cox models were used to assess outcomes (local progression-free survival, disease-free survival, and overall survival). Results: Sixty-five patients (nCRT, n=20; aCRT, n=16; dCRT, n=29) met inclusion criteria [median (range) age 65 years (27–84 years)]. Median posttreatment follow-up was 19.1 months (0.8–164.8 months) for all patients and 38.6, 24.3, and 9.0 months for the nCRT, aCRT, and dCRT groups, respectively. At 3 and 5 years, overall survival was 78% and 59% for the nCRT group; 47% and 35%, aCRT group; and 11% and 0%, dCRT group. Compared with the dCRT group, the nCRT group (hazard ratio =0.13, 95% CI: 0.05–0.33) and the aCRT group (hazard ratio =0.29, 95% CI: 0.14–0.64) had significantly improved overall survival (P<0.001). The 5-year local progression-free survival (50% nCRT vs. 30% aCRT vs. 0% dCRT, P<0.001) and 5-year disease-free survival (61% nCRT vs. 30% aCRT vs. 0% dCRT, P=0.01) were significantly better for strategies combined with surgery. Conclusions: Outcomes for patients with extrahepatic CCA were superior for those who underwent nCRT/orthotopic liver transplant or postsurgical aCRT than for patients treated with dCRT. The excellent outcomes after nCRT/orthotopic liver transplant provide additional independent data supporting the validity of this strategy. The poor survival of patients treated with dCRT highlights a need for better therapies when surgery is not possible.

Original languageEnglish (US)
Pages (from-to)288-297
Number of pages10
JournalJournal of Gastrointestinal Oncology
Volume13
Issue number1
DOIs
StatePublished - Feb 2022

Keywords

  • Cholangiocarcinoma (CCA)
  • Extrahepatic cholangiocarcinoma (extrahepatic CCA)
  • Hilar cholangiocarcinoma (hilar CCA)
  • Liver transplant
  • Neoadjuvant chemoradiation

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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