2015asco不可手术胆管癌有无放化疗的比较分析.ppt

Characterization of unresectable cholangiocarcinoma patients treated with or without chemoradiation,Author(s): Jane Elizabeth Rogers Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX J Clin Oncol 33, 2015 (suppl 3; abstr 403) Reporter DR pengying,Background,Curative treatment for CC is surgical resection. Unfortunately, most CC patients (pts) present with unresectable disease in which gemcitabine plus platinum (GEM-P) chemotherapy is the mainstay of treatment (tx). Advanced CC has a dismal prognosis with 5-year survival reported at 5-10 %. Data regarding chemoradiation (CRT) in pts with unresectable CC (uCC) remains limited.,Introduction,Biliary tract cancers,including cholangiocarcinoma (CC) and gallbladder cancers, are rare with limited data ragarding treatment. Most patients present with unresectable CC resulting in a poor prognosis. CRT is the mainstay of treatment for uCC. There is limited data regarding localized therapy with CRT.,Methods,We retrospectively reviewed uCC pts from 1/1/2009 to 7/31/2013. Primary objective: Determine the percentage of pts treated with CRT Evaluate the median number of chemotherapy cycles given prior to CRT,Secondary objectives: Disease response to first-line tx Duration of CRT control Progression-free survival (PFS) with or without CRT overall survival (OS) with or without CRT,Inclusion criteria: uCC diagnosis, received tx, and had follow-up at our institution. Exclusion criteria: pts who received liver-directed therapy other than CRT, mixed histology tumors, and a history of other malignancies.,Results,114 pts were included with 62% having intrahepatic CC. Median age: 63 Gender: females (53.5%); male (46.5%). Site of disease: intra (62%), Hilar (24%), Extra (14%) .,65% of pts received CRT(7% radiation alone) with a median of 6(range 0-26) chemotherapy cycles given prior to CRT. 66% received gemcitabine + platinum (cisplatin/oxaliplain) as ffirst-line treatment.,Disease control (DC) (response + stable disease) with first-line tx was 75% with 71% receiving GEM-P +/- erlotinib first-line.,DC after CRT was 62% with a median duration of radiation control of 6.4 mths. Median PFS and OS for all pts were 13.4 mths and 27.8 mths, respectively.,Median PFS in the CRT group was 14.5 mths versus 11.4 mths in the no CRT group (p = 0.105). Median OS in the CRT cohort was 29.4 mths, while median OS without CRT was 22.4 mths (p = 0.005).,Median OS and PFS after CRT for pts with DC on first-line tx were 32.0 months (95% CI = 24-44 mths) and 15.7 mths (95% CI =13.5-18.8 mths), respectively. Pts who progressed on first-line tx and received CRT had a median OS of 23.8 mths (95% CI = 7-30 months) and median PFS of 4.2 mths (95% CI = 2.3-9 mths).,Conclusions,Our retrospective review reveals a significant improvement in median OS with CRT in uCC pts. Those with DC on first-line tx showed improvement in PFS and OS with CRT. Patient selection is key