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Cholangiocarcinoma AND unresectability

Pamela J Boimel, Kim Reiss Binder, Theodore S Hong, Mary Feng, Edgar Ben-Josef
Cholangiocarcinoma and gallbladder malignancies are aggressive gastrointestinal malignancies with management dependent on resectability, comorbidities, and location. A multidisciplinary discussion with medical oncologists, radiation oncologists, and surgeons is necessary to determine the optimal treatment approach for each patient. Surgical resection offers the best chance for a long-term cure. Recent studies, such as the phase II SWOG S0809 and the phase III BILCAP study have highlighted the importance of adjuvant treatment with radiation therapy and chemotherapy, respectively, in resected disease...
October 2018: Seminars in Radiation Oncology
Florence K Keane, Andrew X Zhu, Theodore S Hong
Biliary tract cancers (BTCs), including intrahepatic, perihilar and distal cholangiocarcinomas, and gallbladder cancers, are a heterogeneous cohort of tumors that tend to present with advanced stage and with high rates of recurrence after surgical resection. While liver-directed radiotherapy was traditionally restricted to the palliative setting given concerns over hepatotoxicity, modern radiotherapy techniques have enabled safe and effective treatment of a variety of hepatic tumors, thereby expanding the role of liver-directed radiotherapy in the management of BTCs...
October 2018: Seminars in Radiation Oncology
Edward C Lo, Adam N Rucker, Michael P Federle
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) comprise the majority of primary liver cancers. Both HCC and ICC have characteristic imaging appearances on multiphase computed tomography (CT) and magnetic resonance imaging (MRI). Several locoregional therapies, including radiation therapy, are used to treat unresectable disease and residual or recurrent tumor. The tumor response following locoregional therapies has variable imaging manifestations. Focal liver reaction, the imaging changes of the liver following radiation treatment, should be recognized and not mistaken for tumor...
October 2018: Seminars in Radiation Oncology
Wei-Wen Chang, Ping-Kun Hsiao, Lei Qin, Chia-Lun Chang, Jyh-Ming Chow, Szu-Yuan Wu
PURPOSE: No prospective randomized trials have been conducted to date to evaluate the efficacy of palliation of pain or jaundice without treatment, definitive concurrent chemoradiotherapy (CCRT), sequential chemotherapy and radiotherapy (CTRT), or chemotherapy (CT) alone for treating unresectable intrahepatic cholangiocarcinoma (ICC). We designed a nationwide, population-based, cohort study to determine the effects of different treatments on patients with unresectable ICC using propensity score matching (PSM) with the Mahalanobis metric...
September 29, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Koichiro Sakata, Daiki Kijima, Taizo Yamaguchi, Takashi Furuhashi, Toshihiko Abe, Haruki Iwamoto, Katsuhiko Morita
INTRODUCTION: Although curative resection is an outstanding prognostic factor of intrahepatic cholangiocarcinoma (ICC), certain segments remain unresectable. The standard therapy for initially unresectable ICC is uncertain. In this case report, we reported the feasibility of multimodal chemotherapy and curative resection. CASE: A 59-year-old Asian woman with back pain was referred to the hospital by her family physician regarding liver mass visible on ultrasonography...
September 15, 2018: International Journal of Surgery Case Reports
Steffen Marquardt, Martha M Kirstein, Roland Brüning, Martin Zeile, Pier Francesco Ferrucci, Warner Prevoo, Boris Radeleff, Hervé Trillaud, Lambros Tselikas, Emilio Vicente, Philipp Wiggermann, Michael P Manns, Arndt Vogel, Frank K Wacker
OBJECTIVES: Cholangiocarcinoma is the second most common primary liver tumour with a poor overall prognosis. Percutaneous hepatic perfusion (PHP) is a directed therapy for primary and secondary liver malignancies, and its efficacy and safety have been shown in different entities. The purpose of this study was to prove the safety and efficacy of PHP in patients with unresectable intrahepatic cholangiocarcinoma (iCCA). PATIENTS AND METHODS: We retrospectively reviewed data from 15 patients with unresectable iCCA treated with PHP in nine different hospitals throughout Europe...
September 25, 2018: European Radiology
G Lurje, J Bednarsch, C Roderburg, C Trautwein, U P Neumann
Cholangiocarcinoma (CCC) is the second most common primary malignancy of the liver and is typically diagnosed at advanced disease stages. Among curative treatment options for CCC, radical surgical resection with extrahepatic bile duct resection, hepatectomy, and en-bloc lymphadenectomy are considered the mainstay of curative therapy. The assessment of the functional liver reserve by dynamic liver function tests and the estimation of the remaining future liver volume (future liver remnant, FLR) are of paramount importance...
September 4, 2018: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Dalia Elganainy, Emma B Holliday, Cullen M Taniguchi, Grace L Smith, Rachna Shroff, Milind Javle, Kanwal Raghav, Ahmed Kaseb, Thomas A Aloia, Jean Nicolas Vauthey, Ching-Wei D Tzeng, Joseph M Herman, Albert C Koong, Sunil X Krishnan, Bruce D Minsky, Christopher H Crane, Prajnan Das, Eugene J Koay
PURPOSE: To evaluate the effect of escalated dose radiation therapy (EDR, defined as doses >50.4 Gy in 28 fractions [59.5 Gy BED]) on overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) of patients with unresectable extrahepatic cholangiocarcinoma (EHCC). METHODS: A consecutive cohort of 80 patients who underwent radiotherapy for unresectable EHCC from 2001 to 2015 was identified. Demographic, tumor, treatment, toxicity, and laboratory variables were collected...
August 27, 2018: Cancer Medicine
Ankur Pandey, Pallavi Pandey, Mounes Aliyari Ghasabeh, Manijeh Zarghampour, Pegah Khoshpouri, Sanaz Ameli, Yan Luo, Ihab R Kamel
Purpose To evaluate whether baseline MRI can help predict survival in patients with unresectable intrahepatic cholangiocarcinoma (ICCA) undergoing transcatheter arterial chemoembolization (TACE). Materials and Methods This retrospective study was compliant with HIPAA and approved by the institutional review board. The requirement to obtain informed consent was waived. The study included 111 patients (mean age, 62 years ± 12; range, 29-86 years), with 44 men (mean age, 61 years ± 12; range, 29-81 years) and 67 women (mean age, 63 years ± 12; range, 34-86 years)...
August 21, 2018: Radiology
Liu Zhen, Chen Jiali, Fang Yong, Xufeng Han, Pan Hongming, Han Weidong
Purpose: Liver cancer is insensitive to chemotherapy. Sorafenib is currently the standard treatment for patients with advanced diseases, with mild survival extension and several intolerable drug-related side effects. The establishment of new treatments is an unmet clinical need. The aim of our study was to assess the efficacy and safety of apatinib, a novel antiangiogenic drug, in the treatment of patients with liver cancer. Materials and Methods: Patients with unresectable or relapsed liver cancer were included in a single center, retrospective, observational study and treated with apatinib until progressive disease or unacceptable toxicity...
2018: Journal of Cancer
Edward Willems, Bart Smet, Franceska Dedeurwaerdere, Mathieu D'Hondt
Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver malignancy with poor survival rates. Surgical resection is the only curative treatment option, yet only a small portion of cases are resectable. In unresectable situations, suggested therapy consists of a systemic chemotherapy regimen with cisplatinum and gemcitabine. Selective internal radiation therapy (SIRT) has been proposed as an alternative treatment option and may lead to downstaging of unresectable iCCA to surgery. We present a case of a female patient diagnosed with an unresectable iCCA treated with SIRT in order to obtain downstaging...
August 9, 2018: Acta Chirurgica Belgica
Hai-Jie Hu, Yan-Wen Jin, Rong-Xing Zhou, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Fei Liu, Nan-Sheng Cheng, Fu-Yu Li
BACKGROUND: We aimed to examine whether inflammation-based prognostic scores could predict tumor resectability in a cohort of hilar cholangiocarcinoma patients with preoperative hyperbilirubinemia. We also sought to investigate the prognostic factors associated with overall survival in the subgroup of patients with an R0 resection. METHODS: A total of 173 patients with potentially resectable hilar cholangiocarcinoma, as judged by radiological examinations, were included...
August 3, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Colin K Cantrell, Jared White
Cholangiocarcinoma is a rare, but invariably fatal primary hepatic tumor that is often diagnosed at advanced stages with minimal options of surgical cure. Relatively few patients diagnosed with cholangiocarcinoma are considered surgical candidates, owing to the extent of the disease at presentation, the presence of vascular invasion or extrahepatic disease, and/or poor functional status with advanced age being most commonly associated. There is no clear consensus for the management of advanced cholangiocarcinomas, as the current literature is typically based on limited patient numbers and anecdotal experiences at best...
May 28, 2018: Curēus
Xingwei Zhang, Rui Mo, Huijun Zhao, Xi Luo, Yunsheng Yang
BACKGROUND: Photodynamic therapy (PDT) combined with biliary stent showed therapeutic effect in the palliative treatment of unresectable cholangiocarcinoma (CC). We aimed to evaluate the survival outcomes and procedure-related complications of PDT compared to conventional stenting for CC patients. METHODS: Databases including Pubmed, Medline, Embase and Cochrane Central Database were systematically searched from inception to December 2017 for clinical trials compared photodynamic therapy with biliary stenting...
July 26, 2018: Photodiagnosis and Photodynamic Therapy
(no author information available yet)
No abstract text is available yet for this article.
August 2018: Endoscopy
Alexandra Gangi, Jehan Shah, Nathan Hatfield, Johnna Smith, Jennifer Sweeney, Junsung Choi, Ghassan El-Haddad, Benjamin Biebel, Nainesh Parikh, Bulent Arslan, Sarah E Hoffe, Jessica M Frakes, Gregory M Springett, Daniel A Anaya, Mokenge Malafa, Dung-Tsa Chen, Yunyun Chen, Richard D Kim, Ravi Shridhar, Bela Kis
PURPOSE: To evaluate the efficacy and safety of transarterial yttrium-90 glass microsphere radioembolization in patients with unresectable intrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS: Retrospective review of 85 consecutive patients (41 men and 44 women; age, 73.4 ± 9.3 years) was performed. Survival data were analyzed by the Kaplan-Meier method, Cox regression models, and the log-rank test. RESULTS: Median overall survival (OS) from diagnosis was 21...
August 2018: Journal of Vascular and Interventional Radiology: JVIR
Xinjian Wan, Sumin Chen, Qiuyan Zhao, Tian Li, Shengzheng Luo, Xiaobo Cai, Yingchun Ren, Lanting Yu, Baiwen Li
Background/Aims: Although endoscopic metal biliary endoprosthesis (EMBE) is widely accepted as the most suitable drainage method for patients with unresectable malignant obstruction, uncontrolled post-procedural cholangitis is still a problem. We aimed to validate a new treatment modality to prevent post-ERCP cholangitis in patients with unresectable cholangiocarcinoma. Patients and Methods: A total of 378 patients who were diagnosed with unresectable malignant biliary obstruction and underwent EMBE or temporary endoscopic nasobiliary drainage (ENBD) following EMBE placement, from January 2010 to July 2016, were enrolled in this retrospective study...
July 9, 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Riccardo Aurelio Nasto, Paolo Tarantino, Raffaele Fristachi, Luigi Cacace, Sara Bortone
AIM: We evaluated feasibility, safety and efficacy of Electrochemotherapy (ECT) in a prospective series of patients with unresectable Perihilar-Cholangiocarcinoma (PHCCA). PATIENTS AND METHODS: Five patients with PHCCA underwent ECT. Three patients underwent percutaneous ECT of a single PHCCA nodule. One patient underwent resection of a nodule in the IV segment and intraoperative ECT of a large PHCCA in the VIII segment. Another patient underwent percutaneous ECT of a large PHCCA recurrence after left lobectomy and RF ablation of a synchronous metastasis in the VI segment...
October 2018: European Journal of Surgical Oncology
Michael E Lidsky, William R Jarnagin
Hilar cholangiocarcinoma, which represents approximately 60% of biliary tract malignancies, is increasing in incidence and presents an ongoing challenge for patients and hepatobiliary surgeons. Although the majority of patients present with advanced disease, the remaining minority of patients are best treated with surgical resection or transplant. Transplant is typically reserved for locally unresectable tumors often in the setting of underlying hepatic dysfunction and will not be discussed herein. This review, therefore, focuses on oncological resection and the strategies implemented for the treatment of hilar cholangiocarcinoma at a quaternary referral center, including preoperative considerations such as patient selection and optimization of the future liver remnant, nuances to the operative approach for these tumors such as resection under low central venous pressure and management of the bile duct, as well as postoperative management...
July 2018: Annals of gastroenterological surgery
Vivek Verma, Adams Kusi Appiah, Tim Lautenschlaeger, Sebastian Adeberg, Charles B Simone, Chi Lin
Background: Current guidelines recommend chemotherapy (CT) with or without radiotherapy (RT) for unresected intrahepatic cholangiocarcinoma (IC). Although there is currently lack of consensus, previous smaller studies have illustrated the efficacy of local therapy for this population. This investigation evaluated outcomes of chemoradiotherapy (CRT) versus CT alone in unresected IC using a large, contemporary national database. Methods: The National Cancer Data Base (NCDB) was queried for primary IC cases (2004-2013) receiving CT alone or CRT...
June 2018: Journal of Gastrointestinal Oncology
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