Stereotactic Body Radiation Therapy after Chemotherapy for Unresectable Perihilar Cholangiocarcinoma: The STRONG Trial, a Phase I Safety and Feasibility Study
| Autor: | M. Milder, Jan N. M. IJzermans, Lydi M.J.W. van Driel, Alejandra Méndez Romero, Ben J.M. Heijmen, Wilhelm den Toom, Merel S. Koedijk, Yvette van Norden, Dave Sprengers, Ferry A.L.M. Eskens, Rogier Baak, Heinz-Josef Klümpen, Bas Groot Koerkamp, François E. J. A. Willemssen |
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| Přispěvatelé: | Radiotherapy, Radiology & Nuclear Medicine, Medical Oncology, Surgery, Gastroenterology & Hepatology, Oncology, CCA - Cancer Treatment and Quality of Life |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Cisplatin
Cancer Research medicine.medical_specialty Chemotherapy business.industry Stereotactic body radiation therapy medicine.medical_treatment Neoplasms. Tumors. Oncology. Including cancer and carcinogens stereotactic body radiation therapy chemotherapy Article Gemcitabine Radiation therapy SDG 3 - Good Health and Well-being Oncology Quality of life Toxicity Medicine Radiology Stage (cooking) business perihilar cholangiocarcinoma RC254-282 medicine.drug |
| Zdroj: | Cancers Volume 13 Issue 16 Cancers, Vol 13, Iss 3991, p 3991 (2021) Cancers, 13(16):3991. Multidisciplinary Digital Publishing Institute (MDPI) |
| ISSN: | 2072-6694 |
| DOI: | 10.3390/cancers13163991 |
| Popis: | Simple Summary The role of radiotherapy in the treatment of perihilar cholangiocarcinoma has not yet been properly defined. In this prospective study, we therefore explored the addition to first-line chemotherapy of stereotactic body radiation therapy (SBRT) delivered in 15 fractions. Patients eligible for the study had been diagnosed with unresectable perihilar cholangiocarcinoma, and then had no progressive disease after completing treatment with 6–8 cycles of cisplatin-gemcitabine. Primary endpoints were feasibility and safety. Secondary endpoints were local control, progression-free survival, overall survival, and quality of life. As each patient completed the SBRT successfully and no dose-limiting toxicity was found, we consider this treatment to be both feasible and safe. The local control rate and overall survival were promising. However, due to the small sample size of this study, we urge the analysis of this treatment in a larger series of patients. Abstract Background: In unresectable pCCA, the standard of care is palliative chemotherapy. We investigated the feasibility and safety of adding stereotactic body radiation therapy (SBRT) after chemotherapy. Methods: Patients with unresectable pCCA, stage T1-T4N0-N1M0, ECOG 0-1, having finished 6–8 cycles of cisplatin and gemcitabine without disease progression were eligible. SBRT was planned in 15 fractions of 3.0–4.5 Gy. The primary endpoints were feasibility (defined as completing SBRT as planned) and toxicity, evaluated within 3 months after SBRT (CTCAE v4.03). A conventional “3 + 3” design was used, corresponding to a sample size of 6 patients. Dose-limiting toxicity (DLT) was defined as grade ≥ 4 hepatobiliary or grade ≥ 3 gastrointestinal toxicity. The secondary endpoints, measured from the start of radiotherapy, were local control, progression-free survival, overall survival, and quality of life (QoL). ClinicalTrials.gov identifier: NCT03307538. Results: Six patients were enrolled between November 2017 and March 2020. SBRT was delivered as planned. All patients were treated with 60Gy (15 × 4.0Gy). No SBRT-related DLT was observed. The most common grade ≥ 3 toxicity was cholangitis (n = 5). The median follow-up was 14 months. The 12-month local control rate was 80%. We observed no substantial changes in QoL. Conclusion: In patients with unresectable pCCA with stable disease after palliative chemotherapy, adding SBRT is feasible and safe. The observed local control merits an additional evaluation of effectiveness. |
| Databáze: | OpenAIRE |
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