Strahlentherapie und Onkologie

, Volume 195, Issue 2, pp 93–102 | Cite as

Efficacy of stereotactic body radiotherapy for unresectable or recurrent cholangiocarcinoma: a meta-analysis and systematic review

  • Jeongshim Lee
  • Won Sup Yoon
  • Woong Sub Koom
  • Chai Hong RimEmail author
Review Article



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.


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.


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%.


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.


Cholangiocarcinoma Stereotactic body radiotherapy Efficacy Meta-analysis Stereotactic ablative body radiotherapy 

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



Die nichtoperative Behandlung einschließlich der stereotaktischen Strahlentherapie (SBRT) wurde praktisch als alternatives Verfahren für das inoperable oder rezidivierende Cholangiokarzinom (CC) eingesetzt. Wir führten eine systematische Überprüfung und Metaanalyse durch, um die Wirksamkeit der SBRT bei solchen Patienten zu untersuchen.


Die Embase‑, PubMed‑, Medline- und Cochrane-Bibliotheksdatenbanken wurden bis Oktober 2017 systematisch durchsucht. Primärer Endpunkt war die 1‑Jahres-Rate der lokalen Kontrolle (LC). Das 1‑Jahres-Gesamtüberleben (OS), die Ansprechraten und Toxizitätsgrade >3 wurden als sekundäre Endpunkte bewertet.


Elf Studien (226 Patienten) wurden eingeschlossen. Die vorgeschriebene mediane SBRT-Dosis betrug 45 (Bereich 30–55) Gy in 3–5 Fraktionen. Die gepoolte 1‑Jahres-LC-Rate betrug 81,8 % (95 %-Konfidenzintervall [KI] 69,4–89,9 %) in den Studien mit einer äquivalenten Dosis in 2 Gy pro Fraktion (EQD2) ≥71,3 Gy2 und 74,7 % (95 %-KI 57,1–86,7 %) in den Studien mit einer EQD2 <71,3 Gy2. Das mediane OS betrug 13,6 (Bereich 10–35,5) Monate. Die gepoolte 1‑Jahres-OS-Rate betrug 53,8 % (95 %-KI 44,9–62,5 %) und die gepoolte 1‑Jahres-LC-Rate 78,6 % (95 %-KI 69,0–85,8 %). Die häufigsten Toxizitäten waren Ulcus duodeni und Ulcus ventriculi in den verfügbaren Studien mit einer akuten Inzidenz von Grad ≥3 unter 10 % und einer späten Inzidenz von 10 bis 20 %.


Die SBRT war eine machbare Behandlungsoption in Bezug auf die Erreichung einer hohen LC bei inoperablen oder rezidivierenden CC. Die gastrointestinale Toxizität ist akzeptabel, bleibt jedoch ein Hindernis im Zusammenhang mit der Dosiseskalation.


Cholangiokarzinom Stereotaktische Strahlentherapie Wirksamkeit Metaanalyse Stereotaktische ablative Strahlentherapie 


Conflict of interest

J. Lee, W.S. Yoon, W.S. Koom and C.H. Rim declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jeongshim Lee
    • 1
    • 2
  • Won Sup Yoon
    • 3
  • Woong Sub Koom
    • 1
  • Chai Hong Rim
    • 3
    Email author
  1. 1.Department of Radiation OncologyYonsei University College of MedicineSeoulKorea (Republic of)
  2. 2.Department of Radiation OncologyInha University HospitalIncheonKorea (Republic of)
  3. 3.Department of Radiation OncologyKorea University Ansan HospitalAnsanKorea (Republic of)

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