A study from The University of Texas MD Anderson Cancer Center published on Apr. 2 shows that a specialized high-dose radiation treatment may significantly improve survival for patients with large intrahepatic cholangiocarcinoma, or bile duct tumors in the liver. The research appears in Clinical Cancer Research and was led by Ethan Ludmir, M.D., associate professor, and Eugene Koay, M.D., Ph.D., professor of Gastrointestinal Radiation Oncology.
This finding is important because patients with very large liver tumors have traditionally not been treated with radiation due to safety concerns. Improvements in the ability to deliver precise and higher doses of radiation now allow doctors to treat these challenging cases more safely than before.
"Traditionally, patients with very large tumors were not treated with radiation due to safety concerns," Ludmir said. "But our ability to more precisely deliver higher doses of radiation has dramatically improved over the last 10 to 15 years to the point that we can now treat these tumors safely. This study makes a compelling case that there is a very significant benefit from this approach."
The researchers reported that among patients at MD Anderson treated over the past 15 years using this ablative technique, those who received both chemotherapy and high-dose (ablative) radiation had a median overall survival of 28.7 months compared to just 11.9 months for those receiving chemotherapy alone. Tumor-related liver failure rates were also lower—12.1% versus 47.1%. No grade four or five adverse effects occurred; manageable side effects included grade three liver disease in nine patients and late-onset gastrointestinal hemorrhage in two cases.
Koay explained that molecular and histological analyses showed these very large tumors are not fundamentally different from smaller ones: "As a result, it shouldn't come as a surprise that they responded well to ablative radiation like their smaller counterparts. This study has some limitations, but this is very compelling evidence that this approach is effective and safe in a patient population that has a need for better treatment options."
Looking ahead, the authors say their findings provide strong evidence supporting high-dose targeted radiotherapy as an option for patients previously considered unsuitable for such treatment.
