Clinical Outcomes Using Magnetic Resonance–Guided Stereotactic Body Radiation Therapy in Patients With Locally Advanced Cholangiocarcinoma

Elaine Luterstein, Minsong Cao, James M. Lamb, Ann Raldow, Daniel Low, Michael L. Steinberg, Percy Lee

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Purpose: Previous studies have shown that stereotactic ablative radiation therapy (SABR) increases local control for cholangiocarcinoma, but gastrointestinal toxicity resulting from this treatment approach remains a concern. SABR using magnetic resonance–guided radiation therapy (MRgRT) may improve the therapeutic ratio of treatment for cholangiocarcinoma patients given the radiosensitivity of neighboring gastrointestinal organs. Methods: Seventeen consecutive patients with unresectable locally advanced cholangiocarcinoma were treated with SABR using MRgRT between May 2015 and August 2017, subsequent to our previously reported series of patients treated using a standard Linac with cone beam computed tomography. Twelve patients presented with extrahepatic cholangiocarcinoma and 5 patients with intrahepatic tumors. MRgRT-based SABR was administered at a median dose of 40 Gy in 5 fractions. Results: The median overall survival (OS) was 18.5 months, with a 1-year OS of 76% and 2-year OS of 46.1%. Three of the 17 patients progressed locally, yielding a 1-year local control of 85.6% and a 2-year local control of 73.3%. Although 12 of 17 patients experienced an acute grade 1 toxicity, none experienced acute grade 2 toxicities. One patient had an acute grade 3 duodenal ulcer with perforation (6%), and one patient had a late radiation-related toxicity grade 2 gastritis/colitis. Conclusions: Our findings demonstrate diminished toxicity and excellent overall survival and local control. The clinical outcomes and safety profile of SABR delivered with MRgRT suggest that MRgRT is a promising treatment approach for treating cholangiocarcinoma.

Original languageEnglish (US)
Pages (from-to)189-195
Number of pages7
JournalAdvances in Radiation Oncology
Volume5
Issue number2
DOIs
StatePublished - Mar 1 2020
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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