Premium
Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada
Author(s) -
Loveday Benjamin P.T.,
Knox Jennifer J.,
Dawson Laura A.,
Metser Ur,
Brade Anthony,
Horgan Anne M.,
Gallinger Steven,
Greig Paul D.,
Moulton Carolanne
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24833
Subject(s) - medicine , capecitabine , gemcitabine , transplantation , neoadjuvant therapy , liver transplantation , stage (stratigraphy) , radiation therapy , biopsy , surgery , chemotherapy , oncology , cancer , colorectal cancer , paleontology , breast cancer , biology
Background and Objectives Neoadjuvant chemoradiation and liver transplantation may be offered for unresectable perihilar cholangiocarcinoma (pCCA). This study aimed to determine the dropout rate and survival of patients who entered a national tri‐modality protocol. Method Patients enrolled Jan 2009‐Aug 2015 were included. Enrolment criteria: ≤65 years, brush biopsy‐proven unresectable pCCA <3.5 cm diameter. Conformal radiotherapy was given concurrently with Capecitabine. Following surgical staging, patients received maintenance Cisplatin and Gemcitabine until transplant or progression. Time to event analyses were performed from start of neoadjuvant therapy. Results Of 43 patients screened, 18 started treatment; median age 53.9 (26.7‐62.8) years, tumour diameter 2.7 (2.0‐3.4) cm. 11/18 dropped out due to metastatic disease identified during chemoradiation ( n = 2), surgical staging ( n = 6), or maintenance chemotherapy ( n = 3). Six patients underwent transplantation. Median follow up was 17.6 (4.9‐57.7) months and overall survival 16.4 months. One and two year survival was 70.6% and 35.3%, respectively. One and 2 year post transplant survival was 83.3% and 55.6%. Median progression free survival was 11.5 months. Conclusion Neoadjuvant chemoradiation and liver transplantation for unresectable early stage pCCA is feasible, although with high rates of dropout and disease progression. Further research is required to determine factors to help select patients for treatment.