Chemoradiotherapy for Initially Unresectable Locally Advanced Cholangiocarcinoma

Sumiyoshi, Tatsuaki; Shima, Yasuo; Okabayashi, Takehiro; Negoro, Yuji; Shimada, Yasuhiro; Iwata, Jun; Matsumoto, Manabu; Hata, Yasuhiro; Noda, Yoshifumi; Sui, Kenta; Sueda, Taijiro

doi:10.1007/s00268-018-4558-1

Cited by 69 publications

(47 citation statements)

References 32 publications

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“…65 In a recent Japanese study of 15 consecutive patients, 9 were successfully downstaged to R0 resection (60%) with a 5-year overall survival of 24%. 66 Liver transplantation for iCCA iCCA has been a contraindication for LT in most centres worldwide due to very poor initial results, with 2-year survival of around 30%. [67][68][69] The lack of standardised patient selection and the absence of neoadjuvant therapies likely impacted on outcomes.…”

Section: Role Of Neoadjuvant Therapies From a Surgical Perspectivementioning

confidence: 99%

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Mazzaferro

Gorgen

Roayaie

et al. 2020

Journal of Hepatology

254

182

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The incidence of intrahepatic cholangiocarcinoma (iCCA) is increasing worldwide. Although several advances have been made in the past decades to better understand this complex malignancy and to develop new treatment strategies, the prognosis of iCCA remains dismal. Liver resection (LR) is the mainstay of treatment but only a minority of patients are amenable to surgery. In most cases, patients with iCCA will require a major hepatectomy for complete resection of the tumour. This may be contraindicated or increase the surgical burden in patients with chronic liver disease and small remnant liver volume. Lymphadenectomy with a minimal harvest of 6 lymph nodes is considered adequate, as microscopic nodal metastases have been shown in more than 40% of patients. Current 5-year overall survival following LR is in the range of 25%-40%. For locally advanced disease not amenable to upfront LR, neoadjuvant locoregional therapies may be used with the aim of converting these patients to resectability or even to transplantation in well-selected cases. Recent studies have shown that liver transplantation (LT) might be a treatment option for patients with unresectable very-early iCCA (i.e. < − 2 cm), with survival outcomes comparable to those of hepatocellular carcinoma. In patients with unresectable, advanced tumours, confined to the liver who achieve sustained response to neoadjuvant treatment, LT may be considered an option within prospective protocols. The role of adjuvant therapies in iCCA is still under debate. Herein, we review the recent advances in the surgical treatment of iCCA and examine its correlation with locoregional therapies, adjuvant and neo-adjuvant strategies.

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Section: Role Of Neoadjuvant Therapies From a Surgical Perspectivementioning

confidence: 99%

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Mazzaferro

Gorgen

Roayaie

et al. 2020

Journal of Hepatology

254

182

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“…Additionally, neoadjuvant therapy is becoming the standard of treatment of locally advanced pancreatic adenocarcinoma. However, there are few reports on the impact of neoadjuvant therapy in the patients with cholangiocarcinoma, although the efficacy of neoadjuvant therapy followed by surgery for "unresectable" locally advanced cholangiocarcinoma has been reported [14,15].…”

Section: Introductionmentioning

confidence: 99%

High tumor budding is a strong predictor of poor prognosis in the resected perihilar cholangiocarcinoma patients regardless of neoadjuvant therapy, showing survival similar to those without resection

et al. 2020

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Background: Tumor budding (TB) is used as an indicator of poor prognosis in various cancers. However, studies on TB in perihilar cholangiocarcinoma are still limited. We examined the significance of TB in resected perihilar cholangiocarcinoma with or without neoadjuvant therapy. Methods: Seventy-eight patients who underwent surgical resection at our institution for perihilar cholangiocarcinoma from 2004 to 2017, (36 with neoadjuvant therapy), were enrolled in this study. TB was defined as an isolated cancer cell or clusters (< 5 cells) at the invasive front and the number of TB was counted using a 20 times objective lens. Patients were classified into two groups according to TB counts: low TB (TB < 5) and high TB (TB ≥5). Results: In this 78 patient cohort, high TB was significantly associated with advanced tumor status (pT4: 50.0% vs 22.2%, p = 0.007, pN1/2: 70.8% vs 39.6%, p = 0.011, M1: 20.8% vs 1.9%) and higher histological grade (G3: 25.0% vs 5.7%, p = 0.014). Disease specific survival (DSS) in high TB was significantly inferior compared to that in low TB group (3-y DSS 14.5% vs 67.7%, p < 0.001). Interestingly, DSS in high TB showed similar to survival in unresected patients. In addition, high TB was also associated with advanced tumor status and poor prognosis in patients with neoadjuvant therapy. Multivariate analysis identified high TB as an independent poor prognostic factors for DSS (HR: 5.206, p = 0.001). Conclusion: This study demonstrated that high TB was strongly associated with advanced tumor status and poor prognosis in resected perihilar cholangiocarcinoma patients. High TB can be a novel poor prognostic factor in resected perihilar cholangiocarcinoma regardless of neoadjuvant therapy.

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“…Table 2 shows the successful radical resection of the initially unresectable ICC [ 1 , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ]. In previous reports ( Table 2 ), several effective anticancer agents for ICC were administered: mitomycin C, epirubicin; gemcitabine; cisplatin; 5-furuolouracil, capecitabine, and S1.…”

Section: Discussionmentioning

confidence: 99%

Case: Authentic multimodal therapy and liver resection for an initially unresectable intrahepatic cholangiocarcinoma

Sakata

Kijima

Yamaguchi

et al. 2018

International Journal of Surgery Case Reports

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Chemoradiotherapy for Initially Unresectable Locally Advanced Cholangiocarcinoma

Abstract: Chemoradiotherapy allowed patients with initially unresectable locally advanced cholangiocarcinomas to be reclassified as surgical candidates in a substantial proportion. Chemoradiotherapy might be one of the treatment options for similarly advanced cholangiocarcinomas.

Cited by 69 publications

References 32 publications

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Liver resection and transplantation for intrahepatic cholangiocarcinoma

High tumor budding is a strong predictor of poor prognosis in the resected perihilar cholangiocarcinoma patients regardless of neoadjuvant therapy, showing survival similar to those without resection

Case: Authentic multimodal therapy and liver resection for an initially unresectable intrahepatic cholangiocarcinoma

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