Role of radiotherapy, in particular intraluminal brachytherapy, in the treatment of proximal bile duct carcinoma

González, D. González; Gouma, Dirk J.; Rauws, Erik A.; Gulik, Thomas M. van; Bosma, A.; Koedooder, C.

doi:10.1093/annonc/10.suppl_4.s215

Cited by 60 publications

(25 citation statements)

References 29 publications

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“…Similarly, Cheng et al [192] and Schoenthaler et al [193] reported the efficacy of adjuvant radiation for the survival of patients with R1 or R2 resections. Other authors have corroborated the improved survival with adjuvant radiotherapy [194][195][196][197] . Although the bulk of retrospective data suggest that improved survival may be achieved with the use of adjuvant radiation, one prospective study was negative for survival benefit in a selected group of patients with hilar cholangiocarcinoma.…”

Section: Adjuvant Radiotherapymentioning

confidence: 81%

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Surgical strategy for bile duct cancer: Advances and current limitations

Akamatsu

Sugawara²,

Hashimoto³

2011

WJCO

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The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon's ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud's segment Ⅳ coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pyloruspreserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy.

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Section: Adjuvant Radiotherapymentioning

confidence: 81%

“…Gonzalez et al [194] 1999 [193] 1994 R1 resection 11 mo MS 22 mo MS, X-rays 0.010 61 mo MS, charged particles 0.001…”

Section: Nsmentioning

confidence: 99%

Surgical strategy for bile duct cancer: Advances and current limitations

Akamatsu

Sugawara²,

Hashimoto³

2011

WJCO

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“…26 The radiation dose escalation protocol might increase the risk of treatment-related complications such as the development of gastroduodenal ulcers, bowel stricture, biliary-enteric fistulas, and cholangitis. Gonzalez et al 27 warned against radiation dose escalation. They investigated the effects and complications associated with brachytherapy combined with EBRT with a total dose of 50 -68 Gy in 109 patients with proximal bile duct carcinoma (including 71 patients who received tumor resection).…”

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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“…Daneben ist die Lebertransplantation nur für wenige ausgewählte Tumoren geeignet, und es besteht eine hohe Rezidivrate nach zunächst kurativer Operation (bis zu 70%). Deshalb nimmt die palliative Therapie biliärer Tumoren schon rein [48,49,51,[53][54][55]. Auch der Stellenwert einer kombinierten Radiochemotherapie gegenüber der Chemotherapie, der Bestrahlung und lediglich der biliären Drainage ist derzeit ungeklärt [56].…”

Section: Palliative Chemotherapieunclassified

Aktuelle Chemotherapiekonzepte bei Gallengangskarzinomen

Wiedmann

2010

Viszeralmedizin

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Karzinome der Gallenwege sind seltene Tumoren des Gastrointestinaltrakts mit in den letzten Jahren zunehmender Inzidenz. Sie werden unterteilt in intra-und extrahepatische Gallengangskarzinome (Klatskin-Tumor, mittleres und distales Gallengangskarzinom), Gallenblasenkarzinom und Papillenkarzinom. Neoadjuvante bzw. adjuvante Radio-bzw. (Radio-)Chemotherapiekonzepte sind bisher nicht etabliert. Als neuer palliativer Chemotherapiestandard wird eine Kombination aus Cisplatin und Gemcitabin angesehen. Palliative Radio-bzw. Radiochemotherapie sind nur im Rahmen von Studien sinnvoll, da ausreichende Daten bisher fehlen. Erste Studienergebnisse für neue Therapieansätze liegen bereits für Tyrosinkinase-Inhibitoren vor.

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Role of radiotherapy, in particular intraluminal brachytherapy, in the treatment of proximal bile duct carcinoma

Cited by 60 publications

References 29 publications

Surgical strategy for bile duct cancer: Advances and current limitations

Surgical strategy for bile duct cancer: Advances and current limitations

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

Aktuelle Chemotherapiekonzepte bei Gallengangskarzinomen

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