Impact of intraoperative radiotherapy (IORT) on survival of patients with unresectable hilar cholangiocarcinoma.

The cure or long-term survival of hilar cholangiocarcinoma patients can only be achieved after complete tumor resection. Many patients though suffer from unresectable hilar cholangiocarcinoma, and palliative treatment is therefore the only therapeutic option. In cases of unresectable bile duct cancer, intraoperative radiotherapy (IORT) is an additional option during surgery. The aim of this study was to compare the efficacy of IORT to surgery alone in patients with unresectable hilar cholangiocarcinoma.Palliative IORT (group 1) was performed on 9 patients (4 female/5 male); surgery alone (group 2) was performed in a case-matched group of 9 patients (4 female, 5 male) with unresectable hilar cholangiocarcinoma. The mean ages were 52.9 years (group 1) and 57.2 years (group 2). The two groups had comparable local tumor extension and stages of tumor disease according to UICC 6th edition. Group 1 was also compared to all 36 patients (n=36) suffering from unresectable cholangiocarcinoma treated without IORT (Group 3).The survival of patients after IORT was significantly improved compared to surgery alone in this study. The median survival time was 23.3 months (group 1) versus 9.4 months (group 2) and 5.7 month (group 3). The one year and two year actuarial survival rates are: 56% and 42% (group 1), 33% and 0% (group 2), 25% and 8% (group 3).Palliative surgery including IORT is safe for patients with unresectable hilar cholangiocarcinoma. The benefit shown by this investigation is a significant improvement of survival time after application of IORT in the palliative situation. A prospective study with randomization is needed to confirm these first results in a larger cohort.