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

Publication ,  Journal Article
Sudan, D; DeRoover, A; Chinnakotla, S; Fox, I; Shaw, B; McCashland, T; Sorrell, M; Tempero, M; Langnas, A
Published in: Am J Transplant
September 2002

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 6,000 cgy biliary brachy-therapy delivered through percutaneous transhepatic catheters and intravenous infusion of 5-fluorouracil (300mg/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 3.4 months (range = 1-26 months) after diagnosis. Five of the 11 (45%) are alive without evidence of tumor recurrence with a median follow up of 7.5 years (range = 2.8-14.5 years). 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 16 months 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.

Duke Scholars

Published In

Am J Transplant

DOI

ISSN

1600-6135

Publication Date

September 2002

Volume

2

Issue

8

Start / End Page

774 / 779

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Radiotherapy
  • Middle Aged
  • Male
  • Liver Transplantation
  • Iridium Radioisotopes
  • Humans
  • Fluorouracil
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sudan, D., DeRoover, A., Chinnakotla, S., Fox, I., Shaw, B., McCashland, T., … Langnas, A. (2002). Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. Am J Transplant, 2(8), 774–779. https://doi.org/10.1034/j.1600-6143.2002.20812.x
Sudan, Debra, Arnaud DeRoover, Srinath Chinnakotla, Ira Fox, Byers Shaw, Tim McCashland, Mike Sorrell, Margaret Tempero, and Alan Langnas. “Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma.Am J Transplant 2, no. 8 (September 2002): 774–79. https://doi.org/10.1034/j.1600-6143.2002.20812.x.
Sudan D, DeRoover A, Chinnakotla S, Fox I, Shaw B, McCashland T, et al. Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. Am J Transplant. 2002 Sep;2(8):774–9.
Sudan, Debra, et al. “Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma.Am J Transplant, vol. 2, no. 8, Sept. 2002, pp. 774–79. Pubmed, doi:10.1034/j.1600-6143.2002.20812.x.
Sudan D, DeRoover A, Chinnakotla S, Fox I, Shaw B, McCashland T, Sorrell M, Tempero M, Langnas A. Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. Am J Transplant. 2002 Sep;2(8):774–779.
Journal cover image

Published In

Am J Transplant

DOI

ISSN

1600-6135

Publication Date

September 2002

Volume

2

Issue

8

Start / End Page

774 / 779

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Radiotherapy
  • Middle Aged
  • Male
  • Liver Transplantation
  • Iridium Radioisotopes
  • Humans
  • Fluorouracil
  • Female