Top Line: There are a few cancers whose local progression alone is a big contributor to cancer fatality.
The Study: One of these is cholangiocarcinoma where local tumor burden can result in life threatening liver failure. With this in mind, how might aggressive local therapies alter the course of metastatic intrahepatic cholangiocarcinoma? This retrospective analysis looked at 281 patients receiving treatment for metastatic intrahepatic cholangiocarcinoma at MDACC with (n=61) or without (n=220) radiation to the dominant hepatic tumor burden. Of note, the median biologically effective dose (BED10) was a hefty 98 Gy (IQR: 80-98 Gy), and oftentimes smaller volume non-contiguous liver disease was left untreated in order to achieve this. Median overall survival was improved from 9 → 21 months with the addition of radiation. Sure this could simply be a biased selection towards favorable disease, but a sensitivity analysis demonstrated a clear improvement in survival linked to the receipt of radiation among matched controls. This appeared directly correlated with the risk of death due to liver failure being nearly cut in half from 82% → 47% with the addition of radiation, and, even those who did eventually succumb to liver failure after radiation did so at a longer time point (median of 18 months versus 9 months).
TBL: Ablative radiation to dominant liver disease has the potential to prolong survival for metastatic intrahepatic cholangiocarcinoma by delaying or avoiding the most common cause of death: fulminant liver failure. | De, Liver Cancer 2023
The Study: One of these is cholangiocarcinoma where local tumor burden can result in life threatening liver failure. With this in mind, how might aggressive local therapies alter the course of metastatic intrahepatic cholangiocarcinoma? This retrospective analysis looked at 281 patients receiving treatment for metastatic intrahepatic cholangiocarcinoma at MDACC with (n=61) or without (n=220) radiation to the dominant hepatic tumor burden. Of note, the median biologically effective dose (BED10) was a hefty 98 Gy (IQR: 80-98 Gy), and oftentimes smaller volume non-contiguous liver disease was left untreated in order to achieve this. Median overall survival was improved from 9 → 21 months with the addition of radiation. Sure this could simply be a biased selection towards favorable disease, but a sensitivity analysis demonstrated a clear improvement in survival linked to the receipt of radiation among matched controls. This appeared directly correlated with the risk of death due to liver failure being nearly cut in half from 82% → 47% with the addition of radiation, and, even those who did eventually succumb to liver failure after radiation did so at a longer time point (median of 18 months versus 9 months).
TBL: Ablative radiation to dominant liver disease has the potential to prolong survival for metastatic intrahepatic cholangiocarcinoma by delaying or avoiding the most common cause of death: fulminant liver failure. | De, Liver Cancer 2023