胆管癌放疗进展
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胆管癌放疗进展
Radiotherapy of the biliary tract tumors
胆道肿瘤（BTC）
Ø待于重新认识
Ø高异质性
Ø胆囊 Ø肝内胆管 Ø肝外胆管
Patel T et al. Nat Clin Pract Gastroenterol Hepatol 2006; 3: 33–42
Horgan A M et al. JCO 2012;30:1934-1940
Efficacy outcomes for node-positive disease.
Nine studies reporting nodal (n=464) positivity
Horgan A M et al. JCO 2012;30:1934-1940
PubMed (1960 to 2010)
EMBASE (1980 to 2010)
ASCO (1997 to 2010)
Study selection.
This analysis included 20 studies (involving 6,712 patients)
Sites： Biliary tract cancers Gallbladder Intrahepatic Perihilar distal bile ducts
Efficacy outcomes for margin-positive disease.
Nine studies reporting margin positivity (n=340)
Horgan A M et al. JCO 2012;30:1934-1940
思考2
肿瘤异质性 5年生存率 胆囊癌32-53% 肝内胆管癌 23-29% 肝外胆管癌19-35%
145例胆管癌 38例辅助化疗 有59%复发 51%局部区域复发 27%胆道吻合/肝切 缘 16.3%门静脉淋巴结 17.4%后腹膜淋巴结
Ghiassi-Nejad et al. Int J Radiation Oncol Biol Phys 2017: pp. 805e811
思考1Biblioteka Baidu
Ø如何改善预后？
手术 未手术 R2切除 R1切除 R0切除
辅助治疗 单独放疗 单独化疗 放化疗 同步放化疗
如何选择辅助治疗模式
在R0 或R1 切除的患者中，放化疗有优于单纯的放疗的趋势 (CRT vs. RT alone, p = 0.065; cCRT vs. RT alone, p = 0.054)
淋巴结阳性的患者，放化疗明显优于单纯放疗 (CRT vs. RT alone, p < 0.001; cCRT vs. RT alone, p = 0.007)
思考3
Ø病种单一化（胆囊、肝内胆管、肝外胆管） Ø手术模式统一化 Ø辅助治疗的意义是否明确
Ø胆囊癌为例
哪些患者能够从辅助治疗中获益 辅助治疗的模式
胆囊癌辅助治疗
胆囊癌辅助治疗的意义在单中心回顾性研究后并不明确
C.H. Caldow Pilgrim et al. Surgical Oncology xxx (2012) e1-e7
ASCO GI Symposia (2004 to 2010)
ESMO (2002 to 2010)
ØCT ØRT ØCT+RT ØSurgery alone
Horgan A M et al. JCO 2012;30:1934-1940
Efficacy outcomes for overall population.
Figure 1 Location of the nodal areas of potential geographic error
J. Socha et al. Radiotherapy and Oncology 2017; 125: 365–373
Figure 1 Regional nodal recurrence map of Cholangiocarcinoma
临床现状
Ø预后差：5年OS胆囊 5-10%，胆管10-40% Ø手术切除是唯一可能治愈的手段 Ø解剖位置复杂，首诊时<35%可切除 Ø完全切除者，约＞50%发生局部复发 Ø治疗失败以局部复发为主
Eckel F, et al. Ann Oncol Suppl 6: vi40-44, 2011. Howlader N et al. SEER cancer statistics review, 1975-2008, National Cancer Institute de Groen PC et al. N Engl J Med 1999; 341:1368-1378 Jarnagin WR et al. Cancer 2003; 98:1689-1700 Hasegawa S et al. World J Surg 2007; 31:1256-1263 Ghiassi-Nejad et al. Int J Radiation Oncol Biol Phys 2017: pp. 805e811 Marinelli et al. Anticancer Research 2017; 37: 955-962
Ø辅助治疗的获益？ Ø辅助治疗的方式？
单纯化疗CT 单纯放疗RT 同步放化疗CCRT
A meta-analysis of 20 studies involving 6,712 patients showed a nonsignificant improvement in overall survival (OS) with any adjuvant therapy compared with surgery alone (P .06).
Shimada M, et al.Br J Cancer 88: 1463-1466, 2001. Ohtsuka M, et al.J Hepatobiliary Pancreat Surg 10: 259-264, 2003. Uenishi T, et al.J Hepatobiliary Pancreat Surg 15: 417-422, 2008.
Radiotherapy of the biliary tract tumors
胆道肿瘤（BTC）
Ø待于重新认识
Ø高异质性
Ø胆囊 Ø肝内胆管 Ø肝外胆管
Patel T et al. Nat Clin Pract Gastroenterol Hepatol 2006; 3: 33–42
Horgan A M et al. JCO 2012;30:1934-1940
Efficacy outcomes for node-positive disease.
Nine studies reporting nodal (n=464) positivity
Horgan A M et al. JCO 2012;30:1934-1940
PubMed (1960 to 2010)
EMBASE (1980 to 2010)
ASCO (1997 to 2010)
Study selection.
This analysis included 20 studies (involving 6,712 patients)
Sites： Biliary tract cancers Gallbladder Intrahepatic Perihilar distal bile ducts
Efficacy outcomes for margin-positive disease.
Nine studies reporting margin positivity (n=340)
Horgan A M et al. JCO 2012;30:1934-1940
思考2
肿瘤异质性 5年生存率 胆囊癌32-53% 肝内胆管癌 23-29% 肝外胆管癌19-35%
145例胆管癌 38例辅助化疗 有59%复发 51%局部区域复发 27%胆道吻合/肝切 缘 16.3%门静脉淋巴结 17.4%后腹膜淋巴结
Ghiassi-Nejad et al. Int J Radiation Oncol Biol Phys 2017: pp. 805e811
思考1Biblioteka Baidu
Ø如何改善预后？
手术 未手术 R2切除 R1切除 R0切除
辅助治疗 单独放疗 单独化疗 放化疗 同步放化疗
如何选择辅助治疗模式
在R0 或R1 切除的患者中，放化疗有优于单纯的放疗的趋势 (CRT vs. RT alone, p = 0.065; cCRT vs. RT alone, p = 0.054)
淋巴结阳性的患者，放化疗明显优于单纯放疗 (CRT vs. RT alone, p < 0.001; cCRT vs. RT alone, p = 0.007)
思考3
Ø病种单一化（胆囊、肝内胆管、肝外胆管） Ø手术模式统一化 Ø辅助治疗的意义是否明确
Ø胆囊癌为例
哪些患者能够从辅助治疗中获益 辅助治疗的模式
胆囊癌辅助治疗
胆囊癌辅助治疗的意义在单中心回顾性研究后并不明确
C.H. Caldow Pilgrim et al. Surgical Oncology xxx (2012) e1-e7
ASCO GI Symposia (2004 to 2010)
ESMO (2002 to 2010)
ØCT ØRT ØCT+RT ØSurgery alone
Horgan A M et al. JCO 2012;30:1934-1940
Efficacy outcomes for overall population.
Figure 1 Location of the nodal areas of potential geographic error
J. Socha et al. Radiotherapy and Oncology 2017; 125: 365–373
Figure 1 Regional nodal recurrence map of Cholangiocarcinoma
临床现状
Ø预后差：5年OS胆囊 5-10%，胆管10-40% Ø手术切除是唯一可能治愈的手段 Ø解剖位置复杂，首诊时<35%可切除 Ø完全切除者，约＞50%发生局部复发 Ø治疗失败以局部复发为主
Eckel F, et al. Ann Oncol Suppl 6: vi40-44, 2011. Howlader N et al. SEER cancer statistics review, 1975-2008, National Cancer Institute de Groen PC et al. N Engl J Med 1999; 341:1368-1378 Jarnagin WR et al. Cancer 2003; 98:1689-1700 Hasegawa S et al. World J Surg 2007; 31:1256-1263 Ghiassi-Nejad et al. Int J Radiation Oncol Biol Phys 2017: pp. 805e811 Marinelli et al. Anticancer Research 2017; 37: 955-962
Ø辅助治疗的获益？ Ø辅助治疗的方式？
单纯化疗CT 单纯放疗RT 同步放化疗CCRT
A meta-analysis of 20 studies involving 6,712 patients showed a nonsignificant improvement in overall survival (OS) with any adjuvant therapy compared with surgery alone (P .06).
Shimada M, et al.Br J Cancer 88: 1463-1466, 2001. Ohtsuka M, et al.J Hepatobiliary Pancreat Surg 10: 259-264, 2003. Uenishi T, et al.J Hepatobiliary Pancreat Surg 15: 417-422, 2008.