Treatment of Cholangiocarcinoma in Chronic Liver Disease — Perihilar, Under 3 cm, No Extrahepatic Disease
This protocol targets a well-defined patient population: perihilar cholangiocarcinoma (pCCA) measuring less than 3 cm, arising in the setting of chronic liver disease — most commonly primary sclerosing cholangitis — with no evidence of extrahepatic spread.
Clinical scenario
- Perihilar cholangiocarcinoma < 3 cm
- Chronic liver disease (most commonly primary sclerosing cholangitis)
- No extrahepatic disease
In carefully selected patients meeting these criteria, a transplant-directed treatment strategy is associated with long-term disease-free survival.
Treatment approach — partial overview
The protocol employs a neoadjuvant strategy, beginning with external beam radiation therapy delivered concurrently with chemotherapy for chemosensitisation.
Additional locoregional therapy, ongoing systemic treatment, restaging criteria, and full transplant eligibility requirements are detailed in the complete regimen…
References
DOI: 10.1136/gutjnl-2023-330029
- Liver transplantation for selected patients with pCCA in the presence of chronic liver disease (most commonly primary sclerosing cholangitis), less than 3 cm in size with no evidence of extrahepatic disease results in long-term disease-free survival.
- Neoadjuvant therapy involved external beam radiation therapy with concurrent chemotherapy (chemosensitisation), followed by brachytherapy whenever possible.
- Patients were then restaged and continued to receive systemic chemotherapy with oral capecitabine until the time of transplant.
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