Wirksamkeit der stereotaktischen Strahlentherapie bei nichtresektablem oder rezidivierendem Cholangiokarzinom: eine Metaanalyse und systematische Übersicht

Purpose: Non-surgical treatment including stereotactic body radiation therapy (SBRT) have been used practically as alternative modalities for unresectable or recurrent cholangiocarcinoma (CC). We performed a systematic review and meta-analysis to examine the efficacy of SBRT for such patients. Methods: Embase, PubMed, MEDLINE, and Cochrane library databases were searched systematically until October 2017. Primary endpoint was 1‑year local control (LC) rate; 1‑year overall survival (OS), response rates, and grade ≥3 toxicities were assessed as secondary endpoints. Results: Eleven studies (226 patients) were included. The prescribed median SBRT dose was 45 (range 30–55) Gy in 3–5 fractions. The pooled 1‑year LC rate was 81.8% (95% confidence interval [CI] 69.4–89.9%) in the studies using an equivalent dose in 2 Gy per fraction (EQD2) ≥71.3 Gy₂ and 74.7% (95% CI 57.1–86.7%) in the studies using an EQD2 <71.3 Gy₂. The median OS was 13.6 (range 10–35.5) months. The pooled 1‑year OS rate was 53.8% (95% CI 44.9–62.5%) and the pooled 1‑year LC rate was 78.6% (95% CI 69.0–85.8%). Most common toxicity was duodenal ulcer and gastric ulcer in available studies, with the acute incidence of grade ≥3 of less than 10% and the late incidence of 10–20%. Conclusions: SBRT was a feasible treatment option with respect to achieving a high LC for unresectable or recurrent CC. Gastrointestinal toxicity is acceptable, but remains an obstacle related to dose escalation.