Treatment options for locally advanced cholangiocarcinoma
- Christopher D Anderson, MD, FACS
Christopher D Anderson, MD, FACS
- James D. Hardy Professor and Chair, Department of Surgery
- Chief, Transplant and Hepatobiliary Surgery
- University of Mississippi Medical Center
- Keith E Stuart, MD
Keith E Stuart, MD
- Chairman, Department of Hematology and Oncology
- Lahey Hospital and Medical Center
- Professor of Medicine,
- Tufts University School of Medicine
- Manisha Palta, MD
Manisha Palta, MD
- Assistant Professor of Radiation Oncology
- Duke University
- Section Editors
- Richard M Goldberg, MD
Richard M Goldberg, MD
- Section Editor — Gastrointestinal Cancer
- Director of the West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center
- Professor of Medicine
- Laurence S. & Jean J. DeLynn Chair of Oncology
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
Cholangiocarcinomas are rare malignancies arising from the epithelial cells of the intrahepatic and extrahepatic bile ducts. Locally advanced, unresectable cholangiocarcinoma encompasses a heterogeneous mix of patients who fit the following categories:
●Macroscopic residual disease following resection
●Locally advanced, categorically unresectable disease at presentation (see "Treatment of localized cholangiocarcinoma: Adjuvant and neoadjuvant therapy and prognosis", section on 'Preoperative assessment and criteria for resectability')
●Locally recurrent disease after potentially curative treatment
The prognosis for patients with either locally unresectable or locally recurrent disease is typically measured in months, and their lives are characterized by rapid decline with symptoms of progressive biliary obstruction. The goals of palliative therapy are relief of symptoms (pain, pruritus, jaundice) and improvement in quality of life. There is no role for surgical debulking in these cases.
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- OVERVIEW OF THE THERAPEUTIC APPROACH
- ANTINEOPLASTIC THERAPY
- Intrahepatic cholangiocarcinoma
- - Radiotherapy and chemoradiotherapy
- Microscopically positive margins
- Locally unresectable and recurrent disease
- - Neoadjuvant approaches
- - Local ablation and embolization
- Extrahepatic cholangiocarcinoma
- - Radiotherapy and chemoradiotherapy
- Microscopically positive margins
- Locally unresectable and recurrent
- - Neoadjuvant approaches
- - Photodynamic therapy
- Systemic chemotherapy
- Role of orthotopic liver transplantation
- Guidelines from expert groups
- - NCCN
- Intrahepatic cholangiocarcinoma
- Extrahepatic cholangiocarcinoma
- - ESMO
- PALLIATION OF OBSTRUCTIVE JAUNDICE
- Surgical bypass
- - Percutaneous versus endoscopic approach
- - Unilateral versus bilateral stents
- - Plastic versus metal stents
- - Covered versus uncovered stents
- - Prophylactic antibiotics
- SUMMARY AND RECOMMENDATIONS