ArticleJournal of radiation research2026
Proton beam therapy for patients with distal cholangiocarcinoma: a multicenter prospective registry study (Influence of age factor).
Article in Journal of radiation research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This study aimed to investigate the role of proton beam therapy (PT) in patients with unresectable distal cholangiocarcinoma (dCCA), with a special focus on elderly patients. We analyzed data from an updated multi-institutional prospective registry that included all Japanese proton beam facilities. The endpoints were local control (LC), progression-free survival (PFS), overall survival (OS) and toxicity. We included 36 patients with unresectable dCCA who were treated with PT at a median prescribed dose of 60 Gy (RBE) in 30 fractions. With a median follow-up of 12.4 months, the median survival time was 18.9 months, and the 1-year OS were 68.8%. The 1-year LC and PFS rates were 80.6 and 42.7%, respectively. The 1-year OS, LC and PFS rates for elderly patients (aged ≥80 years) were 65.6, 82.3 and 40.9%, respectively, showing no significant difference compared to younger patients (OS: 74.1%, P = 0.853; LC: 78.7%, P = 0.708; PFS: 45.5%, P = 0.654). However, four patients (11.1%) experienced grade ≥3 PT-related adverse reactions, exclusively among elderly patients (4/24 = 16.6% vs. 0/12 = 0% in younger patients, P = 0.278). These reactions were significantly higher with prescribed doses of equivalent 2-Gy fractions (EQD2)>60 Gy (3/6 = 50%) than with EQD2 ≤ 60 Gy (1/30 = 3.3%, P = 0.0104). PT showed good efficacy and acceptable toxicity for unresectable dCCA, even in patients aged ≥80 years, who showed outcomes similar to those of their younger counterparts. However, for elderly patients, a higher prescribed dose of EQD2 ≥60 Gy should be used with caution.
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