Impact of Liver-Directed Radiation Therapy in Patients with Metastatic iCCA

2022 Year in Review: Cholangiocarcinoma — January 4, 2023

Tumor-related liver failure (TRLF) is the most common cause of death in patients with metastatic intrahepatic cholangiocarcinoma (iCCA), accounting for up to 72% of deaths in patients treated with systemic therapy alone.1 A single-institution experience in treating patients with metastatic iCCA with local liver-directed radiation therapy (RT) was presented at the 2022 ASCO annual meeting.

This retrospective analysis included 67 patients with iCCA and extrahepatic metastatic disease who received RT with a biologically equivalent dose (BED) of ≥50 Gy at MD Anderson Cancer Center from January 1, 2011, to March 31, 2021. Patient median age was 63 years (range, 29-83 years); 52.2% were men. The majority of patients (98.5%) received induction chemotherapy, most commonly gemcitabine/cisplatin (65.7%) or gemcitabine, cisplatin, paclitaxel (22.4%). Induction chemotherapy was followed by RT to the primary lesion in the liver; 71.6% received concurrent chemotherapy; the most common concurrent systemic therapy was capecitabine.

Overall, patients received a median RT dose of 60 Gy (range, 40-100 Gy), and 73.1% of patients received a BED of >80.5 Gy. A total of 43 patients had satellitosis; of these, 29 were treated with RT to the dominant liver lesion, and 14 received RT to the primary lesion and ≥1 satellite lesions. Local progression of the radiated lesion was reported in 15 (22.4%) patients; 42 (62.7%) patients progressed elsewhere in the liver, and 52 (77.6%) patients had a distant progression.

TRLF was the cause of death in 28.4% of all patients. Median freedom from TRLF (FFTRLF) was 28.2 months; the 1-year FFTRLF rate was 73.1% and the 2-year FFTRLF rate was 58.2%. Median overall survival (OS) from diagnosis was 25.0 months, and the median OS after RT was 11.9 months; 1-year OS after RT was 47.1%, and 2-year OS after RT was 24.7%.

In a univariate analysis, neither FFTRLF nor OS was significantly correlated with age, sex, performance status, size of liver lesions, tumor or node stage, satellitosis, vascular thrombosis, TRLF, timing of metastasis, site of metastasis, RT technique, or dose of chemotherapy.

The results of this single-institution study indicated that liver-directed RT was associated with favorable TRLF rates and survival times in patients with metastatic iCCA and extrahepatic disease. The authors concluded, “liver-directed radiation therapy can alter the natural history of metastatic iCCA by preventing or delaying liver failure. Future prospective studies are warranted to define the survival benefit in these patients attributable to RT.”


  1. Yamashita S, Koay EJ, Passot G, et al. Local therapy reduces the risk of liver failure and improves survival in patients with intrahepatic cholangiocarcinoma: a comprehensive analysis of 362 consecutive patients. Cancer. 2017;123:1354-1362.

Source: Upadhyay R, Ludmir EB, De B, et al. Preservation of liver function with local radiation therapy in patients with metastatic intrahepatic cholangiocarcinoma with extrahepatic disease. American Society of Clinical Oncology Annual Meeting 2022. Abstract 4080.

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