Cholangiocarcinoma medical therapy: Difference between revisions
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The majority of cases of cholangiocarcinoma present as unresectable disease.<ref>{{cite journal |author=Vauthey J, Blumgart L |title=Recent advances in the management of cholangiocarcinomas |journal=Semin. Liver Dis. |volume=14 |issue=2 |pages=109-14 |year=1994 |pmid=8047893}}</ref> If the tumor cannot be surgically removed, patients are often treated with [[palliation|palliative]] [[chemotherapy]] with or without [[radiotherapy]]. | The majority of cases of cholangiocarcinoma present as unresectable disease.<ref>{{cite journal |author=Vauthey J, Blumgart L |title=Recent advances in the management of cholangiocarcinomas |journal=Semin. Liver Dis. |volume=14 |issue=2 |pages=109-14 |year=1994 |pmid=8047893}}</ref> If the tumor cannot be surgically removed, patients are often treated with [[palliation|palliative]] [[chemotherapy]] with or without [[radiotherapy]]. | ||
===Chemotherapy=== | ===Chemotherapy=== | ||
* 1.'''Chemotherapy''' | * 1.'''Chemotherapy''' | ||
** Preferred regimen (1): 5-fluorouracil with leucovorin | ** Preferred regimen (1): 5-fluorouracil with leucovorin | ||
** | ** Alternative regimen (2): Gemcitabine plus cisplatin | ||
** | ** Alternative regimen (3): Irinotecan | ||
** Alternative regimen (1): Oxaliplatin | ** Alternative regimen (1): Oxaliplatin | ||
** Alternative regimen (2): Doxorubicin | ** Alternative regimen (2): Doxorubicin | ||
** Alternative regimen (3): Capecitabine | ** Alternative regimen (3): Capecitabine | ||
** Alternative regimen (3): | ** Alternative regimen (3): Erlotinib | ||
===Regional therapies=== | ===Regional therapies=== | ||
Revision as of 15:21, 30 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]
Overview
Chemotherapy is indicated for unresectable cholangiocarcinoma as palliative chemotherapy. Chemotherapy agents used to treat cholangiocarcinoma include 5-fluorouracil, gemcitabine, irinotecan, cisplatin, or doxorubicin.
Medical Therapy
The majority of cases of cholangiocarcinoma present as unresectable disease.[1] If the tumor cannot be surgically removed, patients are often treated with palliative chemotherapy with or without radiotherapy.
Chemotherapy
- 1.Chemotherapy
- Preferred regimen (1): 5-fluorouracil with leucovorin
- Alternative regimen (2): Gemcitabine plus cisplatin
- Alternative regimen (3): Irinotecan
- Alternative regimen (1): Oxaliplatin
- Alternative regimen (2): Doxorubicin
- Alternative regimen (3): Capecitabine
- Alternative regimen (3): Erlotinib
Regional therapies
Regional therapies are considered as an option for treating small cholangiocarcinomas when the general health condition of the patient does not permit a more aggressive treatment:
- Transarterial chemoembolization (TACE), which increases the local concentration of chemotherapeutic agents and reduces systemic exposure, has shown promising results, increasing survival.
- Radioembolization also seems to increase survival.
Photodynamic Therapy
Photodynamic therapy, an experimental approach in which patients are injected with a light-sensitizing agent and light is then applied endoscopically directly to the tumor, has shown promising results compared to supportive care in two small randomized controlled trials. However, the ultimate role of photodynamic therapy in the management of cholangiocarcinoma is unclear at present.[2][3]
References
- ↑ Vauthey J, Blumgart L (1994). "Recent advances in the management of cholangiocarcinomas". Semin. Liver Dis. 14 (2): 109–14. PMID 8047893.
- ↑ Ortner M, Caca K, Berr F, Liebetruth J, Mansmann U, Huster D, Voderholzer W, Schachschal G, Mössner J, Lochs H (2003). "Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study". Gastroenterology. 125 (5): 1355–63. PMID 14598251.
- ↑ Zoepf T, Jakobs R, Arnold J, Apel D, Riemann J (2005). "Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy". Am J Gastroenterol. 100 (11): 2426–30. PMID 16279895.