Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy

Kuvshinoff, Boris W.; Armstrong, John G.; Fong, Yuman; Schupak, Karen D.; Getradjman, G.; Heffernan, Nancy; Blumgart, L.H.

doi:10.1002/bjs.1800821122

Cited by 117 publications

(53 citation statements)

References 18 publications

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“…Although RT has frequently been recommended as the main treatment for patients with unresectable hilar cholangiocarcinoma (8,9,20,24,25), the use of percutaneous biliary stenting combined with RT to treat patients with unresectable hilar cholangiocarcinoma is rarely reported. When the background of patients in the two groups was not evidently different, the median stent patency was significantly longer in the UMS+RT group than in the UMS group (326 vs. 196 days; P= 0.022).…”

Section: B Amentioning

confidence: 99%

“…In the previous two decades, percutaneous biliary stenting and radiotherapy (RT) were palliative care programs that were widely used for patients with unresectable hilar cholangiocarcinoma (4)(5)(6)(7)(8)(9). However, the risk of complications of percutaneous biliary stenting was increased compared with the risks of endoscopic biliary stenting (10).…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

et al. 2015

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Abstract. Hilar cholangiocarcinoma is often unresectable at the time of the initial diagnosis, and the provision of a definite palliative benefit is important in patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy (RT) prolonged the stent patency and survival time of patients. In total, the cases of 38 patients with unresectable hilar cholangiocarcinoma that underwent percutaneous biliary stenting at the Navy General Hospital were retrospectively reviewed in the present study. Uncovered metallic stenting (UMS) combined with RT was administered to 25 patients, and UMS alone was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure-associated mortality rate was 2.6%. The median stent patency was 326 days in the UMS+RT group and 196 days in the UMS group (P= 0.022). The UMS+RT group (median, 367 days) demonstrated a longer survival time compared with the UMS group (median, 267 days; P= 0.025). Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with RT may prolong stent patency and patient survival time.

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Section: B Amentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

et al. 2015

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“…However, surgical palliation should be considered if curative resection has been excluded during laparotomy for a planned curative resection. 7 We have reported our 15-year experience with 243 patients subjected to surgery for HCCA at a single medical center with resectability rate 29% in comparison to other centers (36-56%). 8,9 this low resectability can be explained by : first the high incidence of high liver cirrhosis (42%), second most of our patients were referred from rural areas with a long history of jaundice.…”

Section: Discussionmentioning

confidence: 99%

Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

Wahab¹,

Fathy²,

Salah³

et al. 2011

JST

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Background Hilar cholangiocarcinoma (HCCA) is a challenging problem for surgeons because surgery is the only effective therapy for these patients. In this study, we review 15 years of HCCC cases and treatment at a single Egyptian center. Methods From January 1995 to October 2010, 825 patients with HCCC were referred to Gastroenterology Surgical Center, Mansoura University, Egypt. From those 243 underwent potentially curative resection giving respectability rate of 29.4%, and the remaining patients (70.6%) underwent non-surgical treatment because of advanced disease, advanced cirrhosis, poor general condition and distant metastasis and locally advanced diseases. Data were recorded for the 243 cases (subjected to different types of hepatic resection), including demographics, medical history, presenting symptoms, and biochemical, radiological, and pathological parameters. ResultsThe overall resectability rate of the patients studied was 29.4% (243/825). Localized resection, right hepatectomy, or left hepatectomy were completed in 30.5%, 22.6%, and 46.9% respectively, and segment one in 58 % R0 status was achieved in 49.8% of patients. The overall complication rate was 35%. Operative mortality was 6.6% with a five-year survival rate of 16%. Recurrence occurred in 92 (37.8%) the site of recurrence was hepatic (24.3%) and local (13.5%). Resection margin (R0) (P<0.001), lymph node status (P<0.001) (negative), degree of differentiation (P<0.001), segment one resection (P<0.001) (positive), and status of liver (P<0.001) (normal or cirrhotic) predicted statistically higher survival (P<0.001). According to multivariate analysis, R0 lymph node status and well differentiated status. Prediction improved survival among all patients. Conclusion From these case studies, aggressive surgery with caudate lobe resection with normal liver parenchyma may produce better prognoses in patients with resectable HCCA.

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“…8,9 Several retrospective studies demonstrated that radiotherapy prolonged survival in these patients. 10,11 However, to our knowledge, most of these studies included patients with common or distal bile duct carcinoma, who have a better prognosis than patients with hilar duct carcinoma. In 1985, Karani et al 12 reported excellent results after brachytherapy alone for hilar duct carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy combined with transarterial infusion chemotherapy and concurrent infusion of a vasoconstrictor agent for nonresectable advanced hepatic hilar duct carcinoma

Matsumoto¹,

Kiyosue²,

Komatsu³

et al. 2004

Cancer

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BACKGROUNDThe treatment of patients with advanced hepatic hilar duct carcinoma is a challenging problem. The current study was performed to evaluate the outcome of patients with advanced hepatic hilar duct carcinoma who received external beam radiotherapy (EBRT) combined with transarterial chemotherapy and infusion of a vasoconstrictor.METHODSBetween April 1993 and December 2002, 23 patients with histopathologically confirmed hilar duct carcinoma entered the study. The median total dose of EBRT was 41.4 grays (Gy). Transarterial chemotherapy was performed twice during EBRT. It was comprised of an infusion of a cocktail of 20 mg of epirubicin, 10 mg of mitomycin C, and 500 mg of 5‐fluorouracil and was administered 1 minute after injection of epinephrine via a catheter introduced in the hepatic arteries. After the combined treatment, the patients underwent biliary endoprosthesis after evaluation of the initial response to treatment by percutaneous transhepatic cholangiography (PTC). The initial responses based on PTC were classified into four categories: CR, no stenosis; PR, relief of stenosis/obstruction; NC, no change; and PD, progressive stenosis/obstruction. The outcome parameters were survival rates and time, as well as frequency and type of complications.RESULTSExcluding 1 patient who discontinued the treatment, the initial responses of 22 patients were 1 CR (5%), 8 PR (36%), 11 NC (50%), and 2 PD (9%). The response rate was 41%. The overall survival rates at 1 year, 2 years, and 3 years after treatment were 59%, 36%, and 18%, respectively.CONCLUSIONSThe combination of radiotherapy, transarterial infusion chemotherapy, and concurrent infusion of a vasoconstrictor can be delivered safely with good efficacy for patients withadvanced hilar duct carcinoma. Cancer 2004. © 2004 American Cancer Society.

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Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy

Cited by 117 publications

References 18 publications

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

Radiotherapy combined with transarterial infusion chemotherapy and concurrent infusion of a vasoconstrictor agent for nonresectable advanced hepatic hilar duct carcinoma

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