Resectable Cholangiocarcinoma: Reviewing the Role of Adjuvant Strategies

the ONA take:

Cholangiocarcinoma, a rare group of neoplasms originating in the bile duct epithelium, represents only 3% of all gastrointestinal malignancies. Despite its rarity, both the incidence and mortality of cholangiocarcinoma have been rising. The only potentially curative option for this malignancy is surgical resection; however, the rates of resection are very low, thus resulting in a poor prognosis with a 5-year survival rate of approximately 5% to 10%. For the 10% to 40% of patients who are amenable to surgery, the 5-year survival rate increases to 25% to 30%.

Therefore, an evaluation of the benefit of adjuvant strategies following surgical resection to improve the curability rate is critical. A pooled analysis of 20 studies that included a total of 6712 patients demonstrated a nonsignificant survival benefit with adjuvant therapy compared with surgery alone, but those with node positivity or margins involved appeared to derive greater benefit from adjuvant therapy.

Findings from 2 randomized clinical trials have demonstrated effective chemotherapy regimens for the adjuvant setting: mitomycin C plus 5-fluorouracil (5-FU) followed by 5-FU until disease recurrence, and gemcitabine. It remains unclear whether single-agent or double chemotherapy is the optimal approach. Retrospective studies have also suggested that adjuvant radiotherapy may be useful.

Clinical Medicine Insights: Oncology
Clinical Medicine Insights: Oncology

Abstract

Cholangiocarcinoma is a very heterogeneous and rare group of neoplasms originating from the perihilar, intra-, or extrahepatic bile duct epithelium. It represents only 3% of gastrointestinal cancers, although their incidence is increasing as its mortality increases. Surgical resection is the only potentially curative option, but unfortunately the resectability rate is low. Overall, these malignancies have got a very poor prognosis with a five-year survival rate of 5–10%. Although the five-year survival rate increases to 25–30% in the cases amenable to surgery, only 10–40% of patients present with resectable disease. Therefore, it is necessary to optimize the benefit of adjuvant strategies after surgery to increase the rate of curability. This study reviewed the role of adjuvant chemotherapy in resectable bile duct cancers.


Keywords: cholangiocarcinoma, bile duct carcinomas, adjuvant chemotherapy 

INTRODUCTION

Cholangiocarcinoma is a very heterogeneous and rare group of neoplasms originating from the perihilar, intra-, or extra-hepatic bile duct epithelium.1 It represents only 3% of gastrointestinal cancers, although their incidence is increasing.1

Surgical resection represents the only potentially curative option, but unfortunately the resectability rate is low. Overall, these malignancies have got a very poor prognosis with a five-year survival rate of 5–10%. Although in those cases amenable to surgery, the five-year survival rate increases to 25–30%, only 10–40% of patients present with resectable disease.2,5

In any case, the treatment has improved the survival rate, which may result in a better outlook for patients nowadays.6 But efforts are needed to optimize the benefit of adjuvant strategies after surgery to increase the rate of curability.

The present study reviewed the role of adjuvant chemotherapy in resectable bile duct cancers.

BRIEF EPIDEMIOLOGY

Cholangiocarcinoma represents only less than 2% of all human neoplasms,7 but it is the second most common primary hepatic malignancy after hepatocellular carcinoma, accounting for 10–15% of liver malignancies.8

The peak age for cholangiocarcinoma is the seventh decade, with a slightly higher incidence in men. Given the poor prognosis, mortality and incidence rates are similar.8

In the European Union, intrahepatic cholangiocarcinoma (ICC) is 3.2 and 5.4/100,000 per year for males and females, respectively, whereas the ICC is increasing and it is estimated as 0.9–1.3 and 0.4–0.7/100,000 for males and females, respectively.  

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