Neoadjuvant therapy for downstaging of locally advanced hilar cholangiocarcinoma: a systematic review

Grendar, Jan; Grendarova, Petra; Sinha, Richie; Dixon, Elijah

doi:10.1111/hpb.12150

Cited by 53 publications

(33 citation statements)

References 35 publications

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“…No significantly improved OS of these patients was evident regardless of the R0 or R1/2 resection, consistent with results of previous studies [18, 27]. However, other studies have shown a benefit of OS for those patients with positive resection margins (R1/2) or curative resected patients (R0) who received radiation treatment [5, 28]. More studies are warranted to address the optimal radiation dosing and postoperative treatments to improve the outcomes for pCCA patients.…”

Section: Discussionsupporting

confidence: 89%

“…According to the National Cancer Institute's SEER program, the clinical outcomes for patients with perihilar cholangiocarcinoma (pCCA) are poor, with the 5-year survival rate ranging from 25% to 35% for localized cancer to less than 2% for patients with distant metastases [4]. Cholangiocarcinoma is characterized by a poor response to chemotherapy and radiation treatments, and the benefits to these treatments are not yet fully understood [5]. Surgical treatment, especially resections and liver transplantations, are most effective; however, only a few patients are eligible for such treatments because of late diagnoses and the complexity of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Chen

Zhu

et al. 2016

Oncotarget

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As the conventional staging systems have poor prognosis prediction ability for patients with perihilar cholangiocarcinoma (pCCA), we established and validated an effective prognostic nomogram for pCCA patients based on their personal and tumor characteristics. A total of 235 patients who received curative intent resections at the Eastern Hepatobiliary Surgery Hospital from 2000 to 2009 were recruited as the primary training cohort. Age, preoperative CA19-9 levels, portal vein involvement, hepatic artery invasion, lymph node metastases, and surgical treatment outcomes (R0 or R1/2) were independent prognostic factors for pCCA patients in the primary cohort as suggested by the multivariate analyses and these were included in the established nomogram. The calibration curve showed good agreement between overall survival probability of pCCA patients for the nomogram predictions and the actual observations and the concordance index (C-index) was 0.68 (95% CI, 0.61-0.71). The C-index values and time-dependent ROC tests suggested that the nomogram is superior to the conventional staging systems including the Bismuth-Corlette, Gazzaniga, Memorial Sloan Kettering Cancer Center (MSKCC), American Joint Committee on Cancer (AJCC) TNM 7 th edition, and Mayo Clinic. The nomogram also performed better than the traditional staging system in the internal cohort with 93 pCCA patients from the same institution and an external validation cohort including 84 pCCA patients from another institution in predicting the overall survival of the pCCA patients as suggested by the C-index values and the time-dependent ROC tests. In summary, the proposed nomogram has superior predictive accuracy of prognosis for resectable pCCA patients.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Chen

Zhu

et al. 2016

Oncotarget

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“…In a cohort of patients undergoing neoadjuvant chemoradiation prior to liver transplantation, 25 % to 42 % patients had complete pathological response in the resected livers [8]. Improved R0 resectability and improved survival has been reported after neoadjuvant chemoradiation for unresectable hilar cholangiocarcinoma [9][10][11]. The Mayo Clinic schedule of neoadjuvant chemoradiation followed by liver transplantation has reported a 5-year survival of 74 % providing evidence of clinical benefit of the pathological response attained with neoadjuvant chemoradiation [12][13][14][15][16][17].…”

Section: Rationale For Use Of Radiation For Cholangiocarcinomamentioning

confidence: 99%

Positioning high-dose radiation in multidisciplinary management of unresectable cholangiocarcinomas: Review of current evidence

Chopra

Mathew

Shrivastava

2014

Indian J Gastroenterol

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Cholangiocarcinoma is a rare malignancy of the bile ducts. The current standard of care for unresectable nonmetastatic disease is doublet systemic chemotherapy, which provides a median survival of 11.7 months. Although chemoradiation is a therapeutic option that provides almost equivalent or superior survival, the lack of level I evidence presents a major hurdle in routinely recommending it within multidisciplinary clinics. This mini review presents the current evidence on the use of chemoradiation for unresectable nonmetastatic cholangiocarcinoma and rationale for positioning it within multidisciplinary management of unresectable cholangiocarcinomas.

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“…For colorectal and pancreatic cancer, several recent reports also demonstrated a clinical advantage with neoadjuvant chemotherapy (18,19). However, the feasibility and efficacy of neoadjuvant chemotherapy for BTC has not been determined (20). Kato et al reported that patients with initially unresectable locally advanced BTC who underwent neoadjuvant chemotherapy (gemcitabine) had a significantly longer survival time compared with those unable to undergo surgery (2-year overall survival rate of 45 and 19%, respectively) (21).…”

Section: Discussionmentioning

confidence: 99%

Histological complete response in a patient with advanced biliary tract cancer treated by gemcitabine/cisplatin/S-1 combination chemotherapy: A case report

Matsubara

Nishida

Tomimaru

et al. 2016

Molecular and Clinical Oncology

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A 68-year-old woman was referred to our hospital with increased levels of biliary enzymes. On imaging, the patient was diagnosed with unresectable intrahepatic biliary tract cancer (BTC) with invasion of the portal vein and para-aortic lymph node metastasis (cT3N1M1, cStage IVb) and underwent endoscopic biliary drainage for the biliary stricture prior to therapy. The patient was subsequently enrolled in a phase III randomized trial (UMIN000014371/NCT02182778) and randomly assigned to receive gemcitabine/cisplatin/S-1 (GCS) combination therapy intravenously at doses of 1,000 or 25 mg/m2 on day 1 and orally twice daily at a dose of 80 mg/m2 on days 1–7 every 2 weeks. After 12 cycles of scheduled therapy without uncontrollable adverse effects, the patient achieved a good partial response with chemotherapy. Computed tomography (CT) revealed a marked reduction of the primary and metastatic lesions. In addition,18F-fluorodeoxyglucose-positron emission tomography/CT revealed diminishing abnormal uptake and no macroscopic evidence of factors adversely affecting tumor resectability. Therefore, the patient underwent extended right hepatic lobectomy, lymph node dissection and left hepaticojejunostomy. Finally, histological examination of the resected tissues revealed no residual cancer cells, suggesting a pathologically complete response. We herein present the case of a patient with intrahepatic BTC who achieved a pathologically complete response following combination chemotherapy with GCS.

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Neoadjuvant therapy for downstaging of locally advanced hilar cholangiocarcinoma: a systematic review

Cited by 53 publications

References 35 publications

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma

Positioning high-dose radiation in multidisciplinary management of unresectable cholangiocarcinomas: Review of current evidence

Histological complete response in a patient with advanced biliary tract cancer treated by gemcitabine/cisplatin/S-1 combination chemotherapy: A case report

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