Diagnosis and Treatment of Cholangiocarcinoma

Anderson, Christopher; Pinson, C. Wright; Berlin, Jordan; Chari, Ravi S.

doi:10.1634/theoncologist.9-1-43

Cited by 299 publications

(276 citation statements)

References 116 publications

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“…[7][8][9][10]21 Generally, survival for patients with CCC is only 5-9 months without treatment. 5,6,22,23 Surgical hepatic resection of the tumor is the best therapeutic method, and the only generally accepted and potentially curative treatment for patients with CCC in the absence of primary sclerosing cholangitis, however only a small percentage of patients are candidates for curative surgery because of the advanced clinical stage at the time of diagnosis. 14,24,25 Surgical resection showed a median survival time of 13-44 months (26)(27)(28), and a 5-year survival rate of about 4.1-43%.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] In Europe and North America, the average incidence of CCC is 1-2/100,000 per year. 5,6 The incidence during the last years is increasing, and this increasing incidence is associated with an increase in mortality. 2,7-10 Because of an advanced nature of the tumor on the time of first diagnosis, the therapeutic options for patients with unresectable CCC are limited.…”

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confidence: 99%

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Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Vogl

Naguib

Nour-Eldin

et al. 2011

Intl Journal of Cancer

126

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The aim of the study was to evaluate the effectiveness of transarterial chemoembolization (TACE) with four chemotherapeutic protocols in terms of local tumor control and survival of patients with unresectable cholangiocarcinoma (CCC) and to identify the prognostic factors governing treatment success. In the single-centre study, 115 patients (mean ages 5 60.4 years) with unresectable CCC were repeatedly treated with TACE. In total, 819 chemoembolization sessions were performed in 4 week intervals with a mean of 7.1 (range, 3-30) sessions per patient. The chemotherapeutic used was Mitomycin C only in 20.9% of patients, Gemcitabine only in 7%, Mitomycin C with Gemcitabine in 47% and combination of Gemcitabine, Mitomycin C and Cisplatin in 25.1%. Local tumor response was evaluated by MRI according to RECIST. Survival data were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank-test. The local tumor controls were: partial response 8.7%, stable disease 57.4% and progressive disease 33.9% of patients. The median and mean survival times from the start of TACE were 13 and 20.8 months. Survival rate from the start of TACE was 52% after 1-year, 29% after 2-years and 10% after 3-years. Initial tumor response, high tumor vascularity and Child-Pugh class A were statistically significant factors for patient's survival. No statistically significant difference between patients treated with different chemotherapy protocols was noted. In conclusion, TACE is a palliative and safe treatment option for patients with unresectable CCC. Child Pugh class B, tumor hypovascularity and initially progressive disease were poor prognostic factors for patient survival.Cholangiocarcinoma (CCC) is the second most common primary hepatic malignancy following hepatocellular carcinoma. 1 The tumor represents less than 2-3% of all cancers and up to 19% of primary liver cancers worldwide. [1][2][3][4] In Europe and North America, the average incidence of CCC is 1-2/100,000 per year. 5,6 The incidence during the last years is increasing, and this increasing incidence is associated with an increase in mortality. 2,7-10 Because of an advanced nature of the tumor on the time of first diagnosis, the therapeutic options for patients with unresectable CCC are limited.Transarterial chemoembolization (TACE) is a local, catheter-based, minimally invasive therapeutic option for unresectable liver tumors, and is defined as a selective administration of chemotherapy usually combined with embolization of the vascular supply of the tumor. 11 For patients with liver tumors, TACE, as a combination of local-arterial application of chemotherapeutic drugs with additional usage of embolization particles, is an effective and recommended treatment. The concept of TACE has been used in the management of patients with liver metastases from colorectal cancer, breast carcinoma as well as patients with unresectable hepatocellular carcinoma (HCC). [12][13][14][15][16][17] Regarding unresectable CCC there are few...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Vogl

Naguib

Nour-Eldin

et al. 2011

Intl Journal of Cancer

126

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“…There is a broad spectrum of differential diagnosis in patients presenting with diffuse abdominal pain, accelerated bowel transit, increased fatigability, weight loss, all of these symptoms, although not specific, should raise suspicion of a pancreatic or hepatobiliary neoplasm [4].…”

Section: Case Presentationmentioning

confidence: 99%

“…The overall majority of patients present with incurable disease, and the mean survival rate is less than 12 months after the diagnosis [4]. However, treatment alternatives have upgraded throughout the last two decades, combining neoadjuvant or adjuvant chemoradiation with surgical excision and/or radiotherapy [2].…”

Section: Introductionmentioning

confidence: 99%

Over 6-year survival in locally advanced cholangiocarcinoma – a case report

Zugun-Eloae¹,

Ginghină²,

Balan³

et al. 2015

Arch Clin Cases

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Cholangiocarcinoma is a malignancy of the biliary duct system that may originate in the liver and extrahepatic bile duct. Despite aggressive anticancer therapy and interventional supportive care, the overall survival is approximatively 6 months, most patients not being eligible for curative resection.Case description: A 64 year-old patient, diagnosed in 2008 with locally advanced bile duct neoplasm (T3N0M0), who underwent latero-lateral hepatoduodenal anastomosis and cholecystectomy in 2008, followed by neoadjuvant Gemcitabine chemotherapy and cephalic duodenopancreatectomy with tumor exeresis in 2009, uncompliant to follow-up, presents with abdominal meteorism, diffuse abdominal pain, inappetence, weight loss and increased fatigability. Initial ultrasonography showed a localized pancreatic tumor and liquid in the Douglas pouch, both confirmed by CT scan.Discussion: The 6-year survival compared to the general mean survival rate of 17 months, depending on the type of the neoplasm, raises questions about the otherwise histopathology confirmed diagnosis of well differentiated cholangiocarcinoma. The present image documented pancreatic tumor makes the retrospective diagnosis assessment even more intricate. Slow-progressor outlier cases might represent new diagnostic entities, and their understanding can be instrumental in improving the therapeutic efficiency. Long time survival in such diagnostic entities is scarcely reported in literature.

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“…1 Cure is achieved only through surgical resection; yet, greater than 80% of patients present at an advanced and unresectable stage, 2 resulting in a 3-to 6-month median survival from the time of diagnosis. 3 Various palliative treatment strategies have been offered, including chemotherapy, radiation therapy and biliary drainage (endoscopic or percutaneous), but none have …”

Section: Introductionmentioning

confidence: 99%

386 Photodynamic Therapy in Unresectable Cholangiocarcinoma - Not for the Uncommitted

Talreja

Chow

Ellen

et al. 2011

Gastrointestinal Endoscopy

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shown a definitive survival benefit. 2,3 Photodynamic therapy (PDT) is a promising new treatment modality for nonresectable cholangiocarcinoma. Its benefits include symptomatic improvement and prolonged survival with relatively few complications. 2 With PDT, a photosensitizing agent is preferentially retained by the malignant tissue. Following laser activation at a distinct wavelength, toxic oxygen radicals induce apoptosis of malignant cells and cause tumor necrosis. 2-4 PDT has been reported to have a minimal side effect profile, with the most frequently encountered adverse effect being phototoxicity to the skin. 2 In the last few years we have seen the rise of cholangioscopyguided PDT, which allows better identification of tumor margins, permits targeted laser illumination, and aids in evaluating the response to therapy. 5,6 We now report our experience with PDT, in the treatment of cholangiocarcinoma over the past 6 years. (49%) showed Bismuth type IV, 22 (41%) showed Bismuth type III, and six (10%) showed Bismuth type I and II. Twenty patients (37%) received chemotherapy and radiation therapy, five (9%) received chemotherapy only; and one (2%) received radiation therapy only. Mean number of PDT sessions was 1.9±1.5 sessions (range, 1 to 9). Mean survival duration was 293±266 days (median, 190; range, 25 to 1,332). PDT related complications included three (5%) facial burn, three (5%) photosensitivity, and two (3%) rash. Kaplan-Meier analysis comparing the survival means of patients who received PDT and chemotherapy/radiation therapy (median survival 257 days; 95% confidence interval [CI], 166 to 528) versus who received PDT only (median survival 183 days; 95% CI, 129 to 224) showed no significant difference (log-rank p=0.20). Conclusions: PDT has a measurable impact on survival in unresectable cholangiocarcinoma but requires aggressive stenting posttherapy.

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Diagnosis and Treatment of Cholangiocarcinoma

Cited by 299 publications

References 116 publications

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Over 6-year survival in locally advanced cholangiocarcinoma – a case report

386 Photodynamic Therapy in Unresectable Cholangiocarcinoma - Not for the Uncommitted

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