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

• DOI: 10.1053/lv.2000.6143
• Publication Date: 2004-03-19T18:45:17Z
• Authors: Ilja De Vreede; Jeff L. Steers; Patrick A. Burch; Charles B. Rosen; Leonard L. Gunderson; Michael G. Haddock; Lawrence Burgart; Gregory J. Gores
• Keywords: Exploratory laparotomy; Intrahepatic Cholangiocarcinoma

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