Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma

I. De Vreede, Jeff L. Steers, Patrick A. Burch, Charles B. Rosen, Leonard L. Gunderson, Michael Haddock, Lawrence Burgart, Gregory James Gores

Research output: Contribution to journalArticle

252 Citations (Scopus)

Abstract

Orthotopic liver transplantation (OLT) alone for unresectable cholangiocarcinoma is often associated with early disease relapse and limited survival. Because of these discouraging results, most programs have abandoned OLT for cholangiocarcinoma. However, a small percentage of patients have achieved prolonged survival after OLT, suggesting that adjuvant approaches could perhaps improve the survival outcome. Based on these concepts, a protocol was developed at the Mayo Clinic using preoperative irradiation and chemotherapy for patients with cholangiocarcinoma. We report our initial results with this pilot experience. Patients with unresectable cholangiocarcinoma above the cystic duct without intrahepatic or extrahepatic metastases were eligible. Patients initially received external-beam irradiation plus bolus fluorouracil (5-FU), followed by brachytherapy with iridium and concomitant protracted venous infusion of 5-FU. 5-FU was then administered continuously through an ambulatory infusion pump until OLT. After irradiation, patients underwent an exploratory laparotomy to exclude metastatic disease. To date, 19 patients have been enrolled onto the study and have been treated with irradiation. Eight patients did not go on to OLT because of the presence of metastasis at the time of exploratory laparotomy (n = 6), subsequent development of malignant ascites (n = 1), or death from intrahepatic biliary sepsis (n = 1). Eleven patients completed the protocol with successful OLT. Except for 1 patient, all had early-stage disease (stages I and II) in the explanted liver. All patients who underwent OLT are alive, 3 patients are at risk at 12 months or less, and the remaining 8 patients have a median follow-up of 44 months (range, 17 to 83 months; 7 of 9 patients > 36 months). Only 1 patient developed tumor relapse. OLT in combination with preoperative irradiation and chemotherapy is associated with prolonged disease-free and overall survival in highly selected patients with early-stage cholangiocarcinoma.

Original languageEnglish (US)
Pages (from-to)309-316
Number of pages8
JournalLiver Transplantation
Volume6
Issue number3
DOIs
StatePublished - May 2000

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Cholangiocarcinoma
Liver Transplantation
Disease-Free Survival
Fluorouracil
Laparotomy
Survival
Neoplasm Metastasis
Cystic Duct
Recurrence
Drug Therapy
Infusion Pumps
Iridium
Brachytherapy
Ascites

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. / De Vreede, I.; Steers, Jeff L.; Burch, Patrick A.; Rosen, Charles B.; Gunderson, Leonard L.; Haddock, Michael; Burgart, Lawrence; Gores, Gregory James.

In: Liver Transplantation, Vol. 6, No. 3, 05.2000, p. 309-316.

Research output: Contribution to journalArticle

De Vreede, I. ; Steers, Jeff L. ; Burch, Patrick A. ; Rosen, Charles B. ; Gunderson, Leonard L. ; Haddock, Michael ; Burgart, Lawrence ; Gores, Gregory James. / Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. In: Liver Transplantation. 2000 ; Vol. 6, No. 3. pp. 309-316.
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