Effectiveness of Radiation Therapy After Surgery for Hilar Cholangiocarcinoma

Sagawa, Noriaki; Kondo, Satoshi; Morikawa, Toshiaki; Okushiba, Shunichi; Katoh, Hiroyuki

doi:10.1007/s00595-005-2989-4

Cited by 64 publications

(31 citation statements)

References 27 publications

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“…There was no significant difference in median survival between those receiving adjuvant radiation vs those under observation (23 vs 20 months). 38 Adjuvant CRT Therapy In a retrospective review by Nakeeb and Pitt 39 of 44 patients with EHCC, IHCC, or gall bladder cancer, 5FU-based CRT improved median survival to 16.4 months as compared with chemotherapy alone (10.7 months) or radiotherapy alone (7.8 months). Another retrospective study on 65 patients by Borghero et al 40 showed an advantage of CRT in high-risk patients treated adjuvantly.…”

Section: Adjuvant Rtmentioning

confidence: 99%

WITHDRAWN: Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gallbladder Cancer

Williams

Majithia

Wang

et al. 2014

Seminars in Arthroplasty

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Section: Adjuvant Rtmentioning

confidence: 99%

WITHDRAWN: Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gallbladder Cancer

Williams

Majithia

Wang

et al. 2014

Seminars in Arthroplasty

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“…The use of postoperative external beam radiation with or without intraoperative radiotherapy and intraluminal radiotherapy (brachytherapy) has been explored in the adjuvant setting without significant benefits after R0 resections [125,237,238] . On the other hand, several studies showed that adjuvant radiotherapy may benefit patients with positive resection margins [239][240][241] .…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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“…Ein Überlebensvorteil ließ sich in einer retrospektiven Analyse allenfalls tendenziell bei Patienten mit kurativer Resektion von Hilustumoren im p-Stadium III oder IVa erkennen [46]. Bei der perkutanen Bestrahlung umfasst das Zielvolumen die ehemalige Lokalisation des Primärtumors (intraoperativ durch einen Clip markiert) und die befallenen Lymphabflussbahnen.…”

Section: Adjuvante Radiotherapieunclassified

Gibt es eine nichtchirurgische Therapie der Gallenwegskarzinome?

Fuchs

Schepp

2006

Chirurg

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Nonsurgical treatment aims at controlling disease and improving survival and quality of life in patients with nonresectable, recurrent metastatic cholangiocarcinomas. After R0 resection, percutaneous or intraluminal radiotherapy with adjuvant radiochemotherapy may improve survival. Available data, however, are still unsatisfactory, and the efficacy of adjuvant radiochemotherapy after R0 resection remains to be confirmed. Exclusive chemotherapy fails to improve survival postoperatively while, in adequate patients, neoadjuvant chemotherapy can improve R0 resection results. Palliative chemotherapy yielded improved survival and quality of life in only one small prospective randomized trial and cannot be generally recommended at present. Previous biliary stenting for relieving jaundice is mandatory. Beyond established regimens employing 5-fluorouracil/leukovorin and gemcitabine plus platin-based agents, ongoing trials are focussing on topoisomerase-and thyrosine kinase inhibitors. Palliative stenting of malignant bile duct stenoses may eliminate or at least relieve jaundice and pruritus. Single stenting is sufficient for distal bile duct stenoses. In patients with liver metastasis and life expectancy of <6 months, temporary plastic prostheses with 4-6-month patency are sufficient. When the prognosis is for >6 months, self-expanding permanent metal stents, with their significantly longer patency, are superior. In hilar tumors, obstruction of plastic prostheses occurs earlier than in distal bile duct stenoses. Thus, patients with Bismuth II-IV tumors benefit from self-expanding metal stents. These may be inserted by an endoscopic, retrograde approach, percutaneously, or by a combined rendez-vous maneuver. The superiority of bilateral vs unilateral stenting has yet to be proven in Bismuth II-IV tumors. Photodynamic therapy followed by stenting appears to improve survival rates by delaying stent occlusion rather than by regression of the tumoric disease itself.

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Effectiveness of Radiation Therapy After Surgery for Hilar Cholangiocarcinoma

Abstract: Radiation therapy after surgery did not show any clinical benefits for patients with hilar cholangiocarcinoma. However, it may be effective as adjuvant therapy after curative resection in a small subgroup of patients with p-stage III or IVa disease.

Cited by 64 publications

References 27 publications

WITHDRAWN: Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gallbladder Cancer

WITHDRAWN: Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gallbladder Cancer

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Gibt es eine nichtchirurgische Therapie der Gallenwegskarzinome?

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