CholangiocarcinomaChemoradiation treatment with gemcitabine plus stereotactic body radiotherapy for unresectable, non-metastatic, locally advanced hilar cholangiocarcinoma. Results of a five year experience
Section snippets
Patient population
During the period August 2004 to May 2009, 49 patients with Klatskin tumor were referred to our hepatobiliopancreatic surgery group. Ten consecutive patients, seven men and three women (mean age 67.4 ± 8.15 years, range 49–75 years, median 69.5 years), with Unresectable non-metastatic KT were included in this study. Inclusion criteria were: unresectable KT of no more than 6 cm in maximum diameter, normal live function tests, Karnovsky index >70, age >18 and <75 years and given informed consent. Patient’s
Results
All subjects underwent complete staging. Enlarged nodes at the hilum of the liver were identified in six cases. In four cases they were histologically confirmed as metastatic by intraoperative sampling. Median follow-up time was 35.5 months. All patients underwent thin-cut, contrast-enhanced CT before treatment and 7 underwent magnetic resonance imaging with biliary reconstruction. Thin cut CT scan was again performed at 3 and 6 months after treatment and every 6 months thereafter. Tumors were
Discussion
The treatment of non-metastatic unresectable KT remains a clinical challenge that lacks a widely accepted consensus. Many papers reported of this subset of patients with a wide range of proposals varying between extremely aggressive treatments such as orthotopic liver transplantation with or without neoadjuvant radiotherapy [7], [8] to photodynamic therapy [9], [10] or palliative chemotherapy [11], [12], [13], [14], [15], [16] and biliary stenting alone.
Gemcitabine has a well recognized
Conflicts of interest
None.
Funding
None.
References (33)
- et al.
Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer
Int J Radiat Oncol Biol Phys
(2004) - et al.
Liver transplantation for cholangiocellular carcinoma: analysis of a single center experience and review of the literature
Liver Transpl
(2001) - et al.
Stereotactic fractionated radiotherapy for Klatskin tumours
Radiother Oncol
(2010) - et al.
Limitations of conventional doses of chemoradiation for unresectable biliary cancer
Int J Radiat Oncol Biol Phys
(2002) - et al.
External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability
Radiother Oncol
(1996) - et al.
Combined modality treatment in unresectable extrahepatic biliary carcinoma
Int J Radiat Oncol Biol Phys
(2000) - et al.
Stereotactic body radiotherapy for unresectable cholangiocarcinoma
Radiother Oncol
(2010) - et al.
External beam radiotherapy for localized extrahepatic cholangiocarcinoma
Int J Radiat Oncol Biol Phys
(2006) - et al.
Hilar cholangiocarcinoma: current management
Ann Surg
(2009) - et al.
Proximal bile duct cancer: high resectability rate and 5-year survival
Ann Surg
(1999)