Clinical

Transplant and chemoradiation combat cholangiocarcinoma

Last Updated: 2005-09-26 16:25:28 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - A combination approach involving chemoradiation and liver transplantation appears effective in certain patients with hilar cholangiocarcinoma, researchers report in the September issue of Annals of Surgery.

"Combined preoperative radiotherapy and 5-FU chemosensitization with subsequent liver transplantation achieves excellent results for highly selected patients with hilar cholangiocarcinoma," investigator Dr. Charles B. Rosen told Reuters Health.

"Initial results," he added, "exceed those reported with conventional resection and compare favorably with the results of liver transplantation for other indications."

Dr. Rosen and colleagues at the Mayo Clinic, Rochester, Minnesota came to this conclusion following review of the results in patients treated over a 10-year period.

In total, 71 were considered for transplantation and 38 underwent the procedure. Operative staging was used to limit transplantation to patients with localized disease and no lymph node metastases.

Of 54 patients who were assessed for resection, 26 underwent resection. The remaining 28 had unresectable disease.

In the transplantation group, survival at 1 year was 92%, and at 2 and 5 years it was 82%. Corresponding proportions in the resection group were 82%, 48% and 21%. Moreover, the recurrence rate in the transplant patients was 13%, versus 27% in the resection group.

Thus, concluded Dr. Rosen, "hilar cholangiocarcinoma -- once a transplant contraindication -- has re-emerged as an indication for liver transplantation when combined with effective preoperative adjuvant therapy."

Ann Surg 2005;242:451-461.