Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma

Debra Sudan, Arnaud DeRoover, Srinath Chinnakotla, Ira Fox, Byers Shaw, Timothy M McCashland, Michael Floyd Sorrell, Margaret Tempero, Alan Norman Langnas

Research output: Contribution to journalArticle

219 Citations (Scopus)

Abstract

Results of liver transplantation in the treatment of cholangiocarcinoma have been poor as a result of the high incidence of locoregional dissemination and tumor recurrence. This study evaluates the effect of neoadjuvant chemoradiation therapy combined with orthotopic liver transplantation in a carefully selected group of patients with hilar cholangiocarcinoma. Seventeen patients were included in the study. The neoadjuvant protocol included 6000 cgy biliary brachytherapy delivered through percutaneous transhepatic catheters and intravenous infusion of 5-fluorouracil (300 mg/m2/day) until transplantation. Five of the 17 patients demonstrated tumor progression precluding transplantation. One patient died of sepsis on the waiting list. Eleven patients underwent liver transplantation, a median of 3.4months (range=1-26months) after diagnosis. Five of the 11 (45%) are alive without evidence of tumor recurrence with a median follow up of 7.5years (range=2.8-14.5years). Six deaths occurred in the transplanted patients. Tumor recurrence was responsible for two deaths at 10 and 18months, respectively, after transplantation. Three mortalities resulted from bacterial or fungal peritonitis and sepsis. One patient underwent re-transplantation for chronic rejection and died from graft failure resulting from hepatic artery thrombosis 16months after diagnosis without evidence of tumor recurrence. Complications of transhepatic catheter placement included bile duct perforation (n=4) and biliary-portal vein fistula (n=1). All these patients died of tumor recurrence or sepsis. Cholangiocarcinoma should not be considered an absolute exclusion criteria for orthotopic liver transplantation. Long-term, tumor-free survival was achieved in 45% of the transplanted patients. Complications of biliary catheter placement for brachytherapy were associated with poor outcome.

Original languageEnglish (US)
Pages (from-to)774-779
Number of pages6
JournalAmerican Journal of Transplantation
Volume2
Issue number8
DOIs
StatePublished - Sep 1 2002

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Klatskin Tumor
Chemoradiotherapy
Transplantation
Survival
Liver Transplantation
Recurrence
Neoplasms
Sepsis
Cholangiocarcinoma
Catheters
Brachytherapy
Neoadjuvant Therapy
Waiting Lists
Hepatic Artery
Graft Rejection
Portal Vein
Bile Ducts
Peritonitis
Intravenous Infusions
Fluorouracil

Keywords

  • Adjavant therapy
  • Cholangiocarcinoma
  • Liver transplantation
  • Radiochemotherapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. / Sudan, Debra; DeRoover, Arnaud; Chinnakotla, Srinath; Fox, Ira; Shaw, Byers; McCashland, Timothy M; Sorrell, Michael Floyd; Tempero, Margaret; Langnas, Alan Norman.

In: American Journal of Transplantation, Vol. 2, No. 8, 01.09.2002, p. 774-779.

Research output: Contribution to journalArticle

Sudan, Debra ; DeRoover, Arnaud ; Chinnakotla, Srinath ; Fox, Ira ; Shaw, Byers ; McCashland, Timothy M ; Sorrell, Michael Floyd ; Tempero, Margaret ; Langnas, Alan Norman. / Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. In: American Journal of Transplantation. 2002 ; Vol. 2, No. 8. pp. 774-779.
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abstract = "Results of liver transplantation in the treatment of cholangiocarcinoma have been poor as a result of the high incidence of locoregional dissemination and tumor recurrence. This study evaluates the effect of neoadjuvant chemoradiation therapy combined with orthotopic liver transplantation in a carefully selected group of patients with hilar cholangiocarcinoma. Seventeen patients were included in the study. The neoadjuvant protocol included 6000 cgy biliary brachytherapy delivered through percutaneous transhepatic catheters and intravenous infusion of 5-fluorouracil (300 mg/m2/day) until transplantation. Five of the 17 patients demonstrated tumor progression precluding transplantation. One patient died of sepsis on the waiting list. Eleven patients underwent liver transplantation, a median of 3.4months (range=1-26months) after diagnosis. Five of the 11 (45{\%}) are alive without evidence of tumor recurrence with a median follow up of 7.5years (range=2.8-14.5years). Six deaths occurred in the transplanted patients. Tumor recurrence was responsible for two deaths at 10 and 18months, respectively, after transplantation. Three mortalities resulted from bacterial or fungal peritonitis and sepsis. One patient underwent re-transplantation for chronic rejection and died from graft failure resulting from hepatic artery thrombosis 16months after diagnosis without evidence of tumor recurrence. Complications of transhepatic catheter placement included bile duct perforation (n=4) and biliary-portal vein fistula (n=1). All these patients died of tumor recurrence or sepsis. Cholangiocarcinoma should not be considered an absolute exclusion criteria for orthotopic liver transplantation. Long-term, tumor-free survival was achieved in 45{\%} of the transplanted patients. Complications of biliary catheter placement for brachytherapy were associated with poor outcome.",
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