Low rate of active treatment of patients with hilar cholangiocarcinoma

Abstract

INTRODUCTIONThe results of surgical resection and palliative chemotherapy use in hilar cholangiocarcinoma (HC) have been well publicised but the proportion of patients able to undergo these treatments and the comparative outcomes in a population of patients with HC are less well known. METHODS Patients with HC were identified by review of all patients undergoing percutaneous cholangiography over a nineyear period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) in a tertiary facility. The treatment undertaken and outcomes were recorded. RESULTS Overall, 68 patients were identified (37 female) with a median age of 70 years. Forty-five (66%) were treated solely by insertion of a metal stent (median survival 4.73 months) and nine (13%) also received palliative chemotherapy (median survival 13.7 months). Persisting jaundice after stent insertion was noted in 18 of 35 patients (51%) tested within one month of death. Fourteen patients (21%) underwent surgical resection (median survival 20.2 months). CONCLUSIONS Patients undergoing surgical resection had significantly longer survival than those receiving only a palliative stent but not compared with those also receiving palliative chemotherapy, with short-term follow-up. Only a third of patients, however, receive active treatment (surgery or chemotherapy) and improvements in long-term biliary palliation are needed.

A Systematised Literature Review of Real-World Treatment Patterns and Outcomes in Unresectable Advanced or Metastatic Biliary Tract Cancer

“…In line with this, across the extracted observational studies, 22 described the line of treatment as only 'palliative', and therefore these reports are discussed separately from studies designating a line of therapy. Of these reports, half included therapies other than systemic chemotherapy (n = 11), eight palliative systemic chemotherapy (without specifying line of therapy, including gem-based chemotherapies [n = 1], GEMCIS [n = 1], mixed systemic chemotherapies [n = 3], mixed systemic chemotherapies as well as nonactive treatment [n = 3]) and six mixed treatments [57,65,[84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]. In line with BTC treatment guidelines, non-active treatments (including stenting and biliary drainage) were reported in eight studies [57,85,86,88,93,100,102,103].…”