Chemoradiation in unresectable biliary tract cancer: a systematic review
To present a systematic review on efficacy and toxicity of modern concurrent chemoradiation therapy (CCRT) in unresectable biliary tract cancers (BTC). A systematic review of literature published within the last ten years (1 January 2007—31 December 2017), based on PRISMA methodology and using PubMed electronic database was conducted. Only articles reporting patient outcomes in terms of toxicity and/or overall survival (OS) or progression-free survival (PFS) after CCRT, with or without other treatments, were analyzed. Only studies of patients with diagnosis of unresectable BTC, including intrahepatic, extrahepatic, and gallbladder neoplasm were considered. Six eligible studies were included reporting data on 195 patients. Median follow-up ranged between 9.4 and 27.7 months (median: 16 months). Four studies were prospective phase II trials and 2 had a retrospective design. Different external beam radiotherapy (EBRT) techniques and chemotherapy (CT) schedules were used while only in one study a brachytherapy boost was delivered. Grade ≥3 acute toxicity (hematological or gastrointestinal) ranged between 0.0% and 55.6% (median: 37.0%). Late toxicity was not reported by any study. PFS ranged between 6.8 and 10.5 months (median: 7.5 months) in five studies. OS ranged between 9.6 and 13.5 months (median: 13 months) in five studies. CCRT remains a reasonable treatment option for locally advanced BTC, providing results comparable with the ones of standard CT particularly in terms of OS. Considering the progressive advance of modern EBRT techniques, further improvement of these results can be expected. Therefore, clinical trials based on advanced radiotherapy techniques and new integrations of CCRT with systemic treatments are warranted.