Salvage Radiation Therapy for Isolated Local Recurrence of Extrahepatic Cholangiocarcinoma After Radical Surgery: A Retrospective Study

This study investigated the outcomes of salvage radiation therapy (RT) for isolated local recurrence of extrahepatic cholangiocarcinoma (EHCC) after radical surgery. Between May 2003 and July 2011, 25 patients with isolated recurrence of EHCC received RT with the aim of salvage. The most common primary cancer was common bile duct cancer (n = 15) followed by hilar cholangiocarcinoma (n = 7) and pancreaticobiliary type of ampulla of Vater cancer (n = 3). The median disease-free interval from initial operation to recurrence was 12 months. The criteria for diagnosis of recurrence were based on radiographic findings with either computed tomography or positron emission tomography. The radiation dose ranged from 40 to 54 Gy (median 54 Gy), and concurrent chemotherapy was administered to 19 patients. The median follow-up period was 16 months. Local progression occurred in nine patients (36 %). The 2-year local failure-free survival rate was 44 % during a median follow-up period of 14 months. The 2-year overall survival rate was 55 % during a median follow-up period of 24 months. A normal level of CA 19-9 at recurrence and concurrent chemotherapy were favorable prognostic factors for both local control and overall survival. Distant metastasis developed in 11 patients, and the liver was the most common site (n = 7) of distant metastasis. No severe radiation-induced gastrointestinal toxicities developed. Salvage RT with or without concurrent chemotherapy resulted in a median survival of 24 months for patients with isolated local recurrence of EHCC. The treatment was feasible and safe with minimal toxicities.