DEFINITIVE POSTOPERATIVE IRRADIATION OF BILE-DUCT CARCINOMA WITH CHARGED-PARTICLES AND OR PHOTONS

Purpose: To determine the rates of survival and local control in patie nts with bile duct adenocarcinomas treated with post-operative photons and/or charged particles. Methods and Materials: A retrospective stud y was performed analyzing all patients with bile duct adenocarcinomas who received radiotherapy through the University of California San Fra ncisco and at Lawrence Berkeley Laboratory between 1977 and 1987, a to tal of 62 patients. University of California San Francisco patients re ceived photon therapy (median dose 5400 cGy), and Lawrence Berkeley La boratory patients were treated with the charged particles helium and/o r neon (median dose 6000 cGyE). Forty-eight patients were treated post -operatively with curative intent, 30 with photons and 18 with particl es. Thirty-six patients in the study had gross residual disease; none had microscopically negative margins. Results: The overall two-year ac tuarial survival was 28%: 44% for particle-treated patients and 18% fo r patients treated with photons (p = .048). Median actuarial survival was 23 months in particle patients and 12 months in photon patients. L ocal control was also improved, though less significantly, in patients treated with particles (median disease-free survival 20 months vs. 4. 5 months, p = .054). A univariate and multivariate analysis was perfor med and revealed that only extent of residual disease predicted local failure and overall survival; no other prognostic factors were identif ied. Conclusion: Compared to conventional photon radiotherapy, treatme nt with post-operative charged particle irradiation at Lawrence Berkel ey Laboratory appeared to offer a survival advantage in this non-rando mized series. Additional investigation into protection of surrounding normal tissue with better dose localization through the use of charged particles is planned.