Stereotactic radiotherapy for intrahepatic cholangiocarcinoma

Abstract

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive malignancy with an increasing incidence worldwide and poor prognosis, despite several advances and continuous efforts to develop effective treatments. Complete surgical resection is the mainstay of treatment and offers a potentially curative option, but is only possible in less than a third of patients, owing to advanced disease. Chemotherapy is a well-established treatment in the adjuvant and palliative setting, however, confers limited benefit. Conventional radiotherapy is challenging due to local toxicity. With recent advances in stereotactic ablative radiotherapy (SABR), it is now possible to focus ablative beams of radiotherapy precisely aimed at tumours to minimise damage to surrounding viscera. This review details the history, technical background and application of SABR to iCCA, with directions for future research suggested.

Tumour stage and overall survival in patients with intrahepatic cholangiocarcinoma and primary sclerosing cholangitis – a retrospective cohort study

“…Whereas liver transplantation in carefully selected patients with pCCA, e. g., patients with unresectable tumours or tumours in PSC, with a diameter < 3 cm, after neoadjuvant therapy, and in the absence of intrahepatic or extrahepatic metastasis may be considered a therapeutic option, iCCA is widely considered a contraindication for liver transplantation because of high recurrence rates and reduced long-term survival [17,18]. Overall and recurrence-free survival was 38 % and 42 %, respectively, 5 years after liver transplantation, according to a recent meta-analysis [19].…”

Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease

“…CCA: Hepatolithiasis is a risk factor for intrahepatic CCA, which occurs in up to 21.2% of cases[ 3 , 50 - 52 ]. Intrahepatic CCA is an aggressive cancer with poor prognosis, particularly as complete surgical resection is only possible in less than a third of patients[ 53 ]. Patients with hepatolithiasis that develop intrahepatic CCA have higher levels of c-erbB2, epidermal growth factor, COX-2 and nuclear factor-kB, which are biomarkers of chronic inflammation[ 54 - 56 ].…”

Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances

“…Addition of newer neoadjuvant therapies such as stereotactic body radiation therapy (SBRT) have shown promise in preventing disease progression with lower toxicity than traditional external beam radiotherapy and may be beneficial prior to LT[ 62 ]. Oncological therapy has advanced in the management of CCA with improvement of survival with combination of folinic acid, fluorouracil, and oxaliplatin (FOLFOX) as a second line chemotherapy agent[ 63 ] and with recent trial results showing a benefit for immunotherapies in CCA[ 64 ].…”

“… Classification of cholangiocarcinoma[ 62 , 71 ]. A: Anatomical classification of cholangiocarcinoma: Intrahepatic cholangiocarcinoma-proximal to second order bile ducts; Perihilar cholangiocarcinomas-between second order branches of right and/or left hepatic ducts and cystic duct confluence; Distal cholangiocarcinoma-between cystic duct confluence and Ampulla of Vater; B: Bismuth Corlette Classification of perihilar cholangiocarcinoma, .…”