Bile Duct Cancer, Its Survival and Local-Control after Radiotherapy

膽道癌放射線治療後之存活率以及局部控制

張富迪(Fu-Ti Chang) ； 曾雁明(Ngan-Ming Tsang) ； 常佑康(You-Kang Chang) ； 梁為民(Wai-Man Leung)

《放射治療與腫瘤學》 11卷3期 (2004/09) Pp. 133-140

https://doi.org/10.6316/TRO/200411(3)133

摘要

目的：此篇報告提供了本院過去17年來的膽道癌病患放射線治療結果的回溯性分析。此研究乃是根據他們的臨床症狀－報告、手術中發現以及放射線治療給予的方法等去分析存活率以及局部控制率。
材料與方法：自西元1985年至2003年，長庚醫院放射腫瘤科共有228位轉診的膽道癌病患。在此研究中，我們只選擇其中78位沒有遠處器官轉移、並且接受了膽道系統局部病灶治療的病患來加以分析。其中5位病患只接受了腔內放射線治療（ILRT），15位同時接受了體外放射線治療（EBRT）和腔內放射線治療，而58位病患只接受了體外放射線治療。
此研究分析了影響存活率和局部控制率的預後因子。這些因子包括他們的臨床症狀－徵象（黃疸及疼痛）、過去有無肝膽疾病病史、活動能力（performance status，即 Karnofsky scale）、手術中的發現（如淋巴腺體，神經周圍、以及門靜脈有無侵犯）、組織病理報告、CEA值以及放射線治療方法與劑量等。
結果：追蹤期從1個月到160個月不等（中位數17個月）。這78個病患放射線治療後的五年存活率為11.3%，而存活中位數為7個月（95%信賴區間為4.4到9.9個月）。對存活率有負面影響的因素包括：神經周邊和淋巴腺體的侵犯、較差的活動能力、伴有疼痛以及黃疸、組織學細胞分化不良、單一方法的放射線治療、以及較低的放射線劑量等。而影響局部控制率最主要的因素為手術後、放射線治療前，有無殘存的膽道癌病灶。
結論：對於膽道癌病患，建議較高的放射線劑量以得到較好的存活率。而單獨給予腔內放射線治療的效果仍有爭議。既然手術後有無殘存的膽道癌病灶對於局部控制相當關鍵，手術若能完全將腫瘤切除是必要的；若能早期診斷膽道癌，也將能達到更好的治療效果。

關鍵字

膽道癌 ； 放射線治療 ； 預後因子 ； 存活

並列摘要

Purpose: This report retrospectively reviewed bile duct cancer cases at the authors’ institution over the past 17 years. Statistical methods have been employed to analyze overall survival and local-control rates of these cases, and to identify the correlations between different panameters such as the presenting symptoms and signs, surgical findings, radiotherapy (RT) dose, and the RT modality.
Materials and Methods: Between 1985 and 2003, the Department of Radiation Oncology at the Chang Gung Memorial Hospital, Linkou, had 228 patients with bile duct cancer referred for RT. Only the 78 patients with no distant organ metastases who underwent treatment for localized biliary system lesions were included in this study. Five patients received intra-luminal RT (ILRT) alone, 15 had external beam RT (EBRT) plus
ILRT, and 58 patients received EBRT alone. Statistical methods were employed to identify factors that affected overall survival and local-control rates. These factors include patients’ presenting symptoms and signs (jaundice and pain), a past history of hepatobiliary disease, pre-operative performance status (Karnofsky score), surgical findings (lymph node, perineural, and portal vein involvement), histological and pathological classification, CEA level, the radiation modality and the radiation dose.
Results : The follow-up periods ranged from 1-160 months (median 17 months). The 78 patients had a 5-year overall survival rate of 11.3% after RT, and the median survival was 7.0 months (95% CI, 4.4- 9.9 months). Peri-neural and lymph node involvement, poor performance status, presence of pain and/ or jaundice, poorly differentiated histology, single RT modality and lower radiation doses were factors that correlated negatively with
survival. The local control rate was most significantly affected by the presence of residual disease prior to RT.
Conclusion: Higher doses RT offers a better survival to patients with bile duct cancers. The benefit of ILRT given alone remains unclear. Since residual disease appears to be critical for local control, complete resection of the tumor is essential; which reinforces the importance of early diagnosis of bile duct cancer.

並列關鍵字

Bile duct cancer ； Radiotherapy ； Prognostic factor ； Survival