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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers
Gastroenterology, Volume 143, No. 1, Year 2012
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Description
Background & Aims: Excellent single-center outcomes of neoadjuvant chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma caused the United Network of Organ Sharing to offer a standardized model of end-stage liver disease (MELD) exception for this disease. We analyzed data from multiple centers to determine the effectiveness of this treatment and the appropriateness of the MELD exception. Methods: We collected and analyzed data from 12 large-volume transplant centers in the United States. These centers met the inclusion criteria of treating 3 or more patients with perihilar cholangiocarcinoma using neoadjuvant therapy, followed by liver transplantation, from 1993 to 2010 (n = 287 total patients). Center-specific protocols and medical charts were reviewed on-site. Results: The patients completed external radiation (99%), brachytherapy (75%), radiosensitizing therapy (98%), and/or maintenance chemotherapy (65%). Seventy-one patients dropped out before liver transplantation (rate, 11.5% in 3 months). Intent-to-treat survival rates were 68% and 53%, 2 and 5 years after therapy, respectively; post-transplant, recurrence-free survival rates were 78% and 65%, respectively. Patients outside the United Network of Organ Sharing criteria (those with tumor mass >3 cm, transperitoneal tumor biopsy, or metastatic disease) or with a prior malignancy had significantly shorter survival times (P <.001). There were no differences in outcomes among patients based on differences in surgical staging or brachytherapy. Although most patients came from 1 center (n = 193), the other 11 centers had similar survival times after therapy. Conclusions: Patients with perihilar cholangiocarcinoma who were treated with neoadjuvant therapy followed up by liver transplantation at 12 US centers had a 65% rate of recurrence-free survival after 5 years, showing this therapy to be highly effective. An 11.5% drop-out rate after 3.5 months of therapy indicates the appropriateness of the MELD exception. Rigorous selection is important for the continued success of this treatment. © 2012 AGA Institute.
Authors & Co-Authors
Harnois, Denise M.
United States, Jacksonville
Mayo Clinic in Jacksonville, Florida
Kulik, Laura M.
United States, Evanston
Northwestern University
Botha, Jean F.
United States, Omaha
University of Nebraska Medical Center
Chapman, William C.
United States, St. Louis
Washington University School of Medicine in St. Louis
Emond, Jean Crawford
United States, New York
Columbia University Irving Medical Center
Gores, Gregory J.
United States, Rochester
Mayo Clinic
Heimbach, Julie K.
United States, Rochester
Mayo Clinic
Statistics
Citations: 428
Authors: 7
Affiliations: 12
Identifiers
Doi:
10.1053/j.gastro.2012.04.008
ISSN:
00165085
Research Areas
Cancer
Health System And Policy