Outcome of Gemcitabine Based Chemoradiation for Loco-Regional Cholangiocarcinoma

Purpose: Surgery remains the primary treatment of cholangiocarcinoma, with concurrent chemoradiation (CCRT) reserved for adjuvant treatment or as primary treatment for unresectable disease. However, the experience has been limited to flourauracilbased chemoradiation. A retrospective analysis of gemcitabine based CCRT as primary treatment for loco-regional cholangiocarcinoma in our institute was performed. Materials and Methods: Between April, 2004 and December, 2012, 26 patients (M/F=17/9; median age=66years) with cholangiocarcinoma (14 intrahepatic primary and 12 perihilar or extrahepatic primary) were treated with curative intent at our department. Baseline performance status based on Eastern Cooperative Oncology Group (ECOG) was 0-1 in 22 patients and 2 in 4 patients. Nine had regional extension of the diseases (defined as metastasis in either regional or para-aortic lymph nodes), whereas 17 had localized (T1-4N0M0) disease. The median equivalent dose in 2 Gy (EQD2) was 52.0 Gy (range: 40-72.1 Gy). Concurrent chemotherapy was low dose gemcitabine at 400 mg/m2 given weekly to biweekly. Both univariateand multivariate analyses were used to identify statistically significant prognostic factors. Results: The median survival of the entire cohort was 13.2 months. Survival rates at 1 and 2 year were 53% and 8% respectively. Patients of better performance status (ECOG 0-1) had improved median survival in comparison to those who of poorer baseline performance status (ECOG 2) (16.9 months vs. 1.5 months, p=0.045) on univariate analysis. Younger age (＜ 66 years) trended towards improved median survival (28.0 months vs. 4.8 months, p=0.055). There was eight local failures, two of which were isolated local failures. There were two treatment-related deaths. Conclusions: Outcome of low dose gemcitabine CCRT for cholangiocarcinoma seems promising. Those with better baseline performance status are most likely to benefit from this treatment. Definitive gemcitabine based CCRT for loco-regional cholangiocarcinoma may be an alternative to primary surgery.