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Topics:
Radiation Oncology • Gastrointestinal Cancers • Medical Oncology • Liver and Pancreas Tumors • Cholangiocarcinoma
How do you sequence hypofractionated radiation and systemic therapy for patients with unresectable cholangiocarcinoma?
When using hypofractionated RT (i.e., 67.5 Gy in 15 fractions), can chemotherapy be delivered concurrently?
Options for systemic therapy in NCCN are listed as either durvalumab/gemcitabine/cisplatin or pembrolizumab/gemcitabine/cisplatin, but is this only for when disease is managed by systemic therapy alone?
Answer from: Radiation Oncologist at Community Practice
I have generally cared for patients analogously to that done in the initial NRG GI001 or ABC07 trial designs with the use of initial systemic therapy for 3-6 months followed by consolidative RT targeting a BED > 80.5, assuming a/b ratio of 10 Gy. Tao et al., PMID 26503201 In my practice...
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Answer from: Radiation Oncologist at Academic Institution
If one defines the standard of care by what most people do, they start with chemotherapy for someone who cannot have surgery for IHCC. However, logically since ablative radiation controls these to the same degree that surgery does, it is also reasonable to start with radiation and I have done that. ...
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Medical Oncologist at St Louis Cancer Care LLP
Thanks for your excellent summary. Another reason ...
Thanks for your excellent summary. Another reason ...
Answer from: Radiation Oncologist at Academic Institution
Our institutional approach depends on the initial risk for widespread disease.
In patients who would otherwise be potentially cured with surgery (i.e., localized intrahepatic disease), we treat all areas of involvement with ablative radiotherapy. We usually offer observation after this. If there is...