Combined treatment for locally advanced cholangiocellular liver cancer - the case report

Liver resection is the standard in the treatment of patients with the local uncomplicated intrahepatic bile duct cancer. Systemic chemotherapy is prescribed in the presence of distant metastases. Difficulties in a choice of the treatment method come up when one or several factors are revealed: the tumor spread towards the surrounding structures, multiple liver lesions, lymph nodes involvement signs. The complications presence manages treatment strategy too. The case describes the possibilities of an individual multimodal approach in a treatment strategy for the patient with locally advanced liver cholangiocarcinoma complicated by obstructive jaundice, cholangitis, cholangiogenic abscesses. The surgical approach was approved as the main one. Methods of interventional radiology, chemotherapy, radiation therapy were applied when necessary. The mentioned above treatment strategy allowed us to achieve good results in this difficult clinical case. The patient is alive for more than four years from the time of surgery, signs of progression are not currently defined.

1. Weber SM, Ribero D, O'Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015 Aug; 17(8):669-680. DOI: 10.1111/hpb.12441

2. Ribero D, Pinna AD, Guglielmi A, Ponti A, Nuzzo G, Giulini SM, et al. Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients. Arch Surg. 2012 Dec; 147(12):1107-1113. DOI: 10.1001/archsurg.2012.1962

3. Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Sueda T. Intrahepatic cholangiocarcinoma: clinicopathological differences between peripheral type and hilar type. J Gastrointest Surg. 2012 Mar; 16(3):540-548. DOI: 10.1007/s11605-011-1730-4

4. Waseem D, Tushar P. Intrahepatic, perihilar and distal cholangiocarcinoma: Management and outcomes. Ann Hepatol. 2017; 16(1):133-139. DOI: 10.5604/16652681.1226927

5. Cho Y, Kim TH, Seong, J. Improved oncologic outcome with chemoradiotherapy followed by surgery in unresectable intrahepatic cholangiocarcinoma. Strahlenther Onkol. 193(8):620-629. DOI: 10.1007/s00066-017-1128-7

6. Putzer D, Schullian P, Jaschke WR, Bale R. Minimally invasive locoregional treatment of intrahepatic cholangiocellular carcinoma. Surg. Gastroenterol. Oncol. 2018; 23(5):303-308. DOI: 10.21614/sgo-23-5-303

7. Park JO, Oh DY, Hsu C, Chen JS, Chen LT, Orlando M, et al. Gemcitabine Plus Cisplatin for Advanced Biliary Tract Cancer: A Systematic Review. Cancer Res Treat. 2015 Jul; 47(3):343-361. DOI: 10.4143/crt.2014.308

8. Gabriel E, Gandhi S, Attwood K, Kuvshinoff B, Hochwald S, Iyer R. Gemcitabine and capecitabine for advanced biliary cancer. J Gastrointest Oncol. 2017 Aug; 8(4):728-736. DOI: 10.21037/jgo.2017.01.24

9. Shroff RT, Javle MM, Xiao L, Kaseb AO, Varadhachary GR, Wolff RA, et al. Gemcitabine, cisplatin, and nabpaclitaxel for the treatment of advanced biliary tract cancers. A phase 2 clinical trial. JAMA Oncol. 2019 Jun 1; 5(6):824-830. DOI: 10.1001/jamaoncol.2019.0270

10. Kato A, Shimizu H, Ohtsuka M, Yoshidome H, Yoshitomi H, Furukawa K, et al. Surgical resection after downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer: a retrospective single-center study. Ann Surg Oncol. 2013 Jan 1; 20(1):318-324. DOI: 10.1245/s10434-012-2312-8

11. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010 Apr 8; 362(14):1273-1281. DOI: 10.1056/NEJMoa0908721

12. Imperatori M, D'Onofrio L, Marrucci E, Pantano F, Zoccoli A, Tonini G. Neoadjuvant treatment of biliary tract cancer: state-of-the-art and new perspectives. Hepat Oncol. 2016 Jan; 3(1):93-99 DOI: 10.2217/hep.15.43

13. Primrose JN, Fox RP, Palmer DH, Malik HZ, Prasad R, Mirza D, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019 May 1; 20(5):663-673. DOI: 10.1016/S1470-2045(18)30915-X

14. Edeline J, Benabdelghani M, Bertaut A, Watelet J, Hammel P, Joly JP, et al. Gemcitabine and oxaliplatin chemotherapy or surveillance in resected biliary tract cancer (PRODIGE 12-ACCORD 18-UNICANCER GI): a randomized phase III study. J Clin Oncol. 2019 Mar 10; 37(8):658-667. DOI: 10.1200/JCO.18.00050

15. Miura JT, Johnston FM, Tsai S, George B, Thomas J, Eastwood D, et al. Chemotherapy for Surgically Resected Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2015 Oct; 22(11):3716-3723. DOI: 10.1245/s10434-015-4501-8

16. Morine Y, Shimada M, Ikemoto T, Arakawa Y, Iwahashi S, Saito YU, et al. Effect of Adjuvant Gemcitabine Combined with Lowdose 5-Fluorouracil and Cisplatin Chemotherapy for Advanced Biliary Carcinoma. Anticancer Res. 2017 Nov; 37(11):6421-6428. DOI: 10.21873/anticanres.12096

17. Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, et al. Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann Surg Oncol. 2011 Mar; 18(3):651-658. DOI: 10.1245/s10434-010-1325-4