The current role of radiotherapy and systemic therapy in the multidisciplinary treatment of cholangiocarcinoma


Authors: Renata Soumarová 1;  Robert Gürlich 2;  Jan Hajer 3;  Martin Oliverius 2;  Martina Kubecová 1;  Markéta Šejdová 1;  Marián Liberko 1;  Katarína Kološtová 4
Authors‘ workplace: Radioterapeutická a onkologická klinika 3. LF UK a FN Královské Vinohrady, Praha 1;  Chirurgická klinika 3. LF UK a FN Královské Vinohrady, Praha 2;  2. interní klinika 3. LF UK a FN Královské Vinohrady, Praha 3;  Ústav laboratorní diagnostiky 3. LF UK a FN Královské Vinohrady, Praha 4
Published in: Čas. Lék. čes. 2019; 158: 78-82
Category: Review Article

Overview

Cholangiocarcinoma is a cancer with very poor prognosis. The only potentially curative approach is surgical resection of tumor. However, the rate of local and distant recurrence after radical surgery is still high. Benefit of adjuvant therapy is not clearly defined, nevertheless patients at high risk of recurrence are indicated to chemotherapy or chemoradiotherapy. Locally advanced, unresectable disease can also be treated with chemotherapy alone, or with her combination with radiotherapy. Required radiation doses are relatively high, therefore it is necessary to use highly conformal radiation therapy.

Treatment of metastatic disease is currently based on systemic therapy, combination of gemcitabine and cisplatin as standard of care. Benefit of targeted molecular therapy is not clear at present, but ongoing research in genetic profiling of tumor may help to improve current clinical practice. Patients with cholangiocarcinoma have to be discussed during multidisciplinary team meetings.

Keywords:

cholangiocarcinoma – radiotherapy adjuvant – drug therapy – targeted therapy


Sources
  1. Horgan AM, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol 2012; 30(16): 1934–1940.
  2. Ghidini M, Tomasello G, Botticelli A et al. Adjuvant chemotherapy for resected biliary tract cancers: a systematic review and meta-analysis. HPB (Oxford). 2017; 19(9): 741–748.
  3. Edelin J, Bonnetain F, Phelip JM et al. GEMOX versus surveillance following surgery of localized biliary tract cancer: results of the PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. Poster session and oral abstract session. Gastrointestinal Cancers Symposium, San Francisco, 19.–21. 1. 2017.
  4. Primrose JN, Fox R, Palmer DH et al. Adjuvant capecitabine for biliary tract cancer. The BILCAP randomized study. ASCO annual meeting 2017, abstract 4006.
  5. Stein A, Arnold D, Bridgewater J et al. Adjuvant chemotherapy with gemcitabine and cisplatin compared to observation after curative intent resection of cholangiocarcinoma and muscle invasive gallbladder carcinoma (ACTICCA-1trial) - a randomized, multidisciplinary, multinational phase III trial. BMC Cancer 2015; 15: 564.
  6. NCCN guidelines, version 2.2019. Dostupné na: www.nccn.org
  7. Houry S, Haccart V, Huguier M, Schlienger M. Gallbladder cancer: role of radiation therapy. Hepatogastroenterology 1999; 46(27): 1578–1584.
  8. Kresl JJ, Schild SE, Henning GT et al. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma. Int J Radiat Oncol Biol Phys 2002; 52(1): 167–175.
  9. Kim Y, Amini N, Wilson A et al. Impact of chemotherapy and external-beam radiation therapy on outcomes among patients with resected gallbladder cancer: a multi-institutional analysis. Ann Surg Oncol 2016; 23(9): 2998–3008.
  10. Hoehn RS, Wima K, Ertel AE et al. Adjuvant therapy for gallbladder cancer: an analysis of the National Cancer Data Base. J Gastrointest Surg 2015; 19(10): 1794–1801.
  11. Bergquist JR, Shah HN, Habermann EB et al. Adjuvant systemic therapy after resection of node positive gallbladder cancer: Time for a well-designed trial? Results of a US-national retrospective cohort study. Int J Surg 2018; 52: 171–179.
  12. Kwon J, Kim BH, Kim K et al. Survival benefit of adjuvant chemoradiotherapy in patients with ampulla of Vater cancer: a systematic review and meta-analysis. Ann Surg 2015; 262(1): 47–52.
  13. Bonet Beltrán M, Allal AS, Gich I et al. Is adjuvant radiotherapy needed after curative resection of extrahepatic biliary tract cancers? A systematic review with a meta-analysis of observational studies. Cancer Treat Rev 2012; 38(2): 111–119.
  14. Abdel-Rahman O, Elsayed Z, Elhalawani H. Gemcitabine-based chemotherapy for advanced biliary tract carcinomas. Cochrane Database Syst Rev 2018; 4: CD011746.
  15. Pollom EL, Alagappan M, Park LS et al. Does radiotherapy still have a role in unresected biliary tract cancer? Cancer Med 2017; 6(1): 129–141.
  16. Phelip JM, Vendrely V, Rostain F et al. Gemcitabine plus cisplatin versus chemoradiotherapy in locally advanced biliary tract cancer: Fédération Francophone de Cancérologie Digestive 9902 phase II randomised study. Eur J Cancer 2014; 50(17): 2975–2982.
  17. Tao R, Krishnan S, Bhosale PR et al. Ablative radiotherapy doses lead to a substantial prolongation of survival in patients with inoperable intrahepatic cholangiocarcinoma: a retrospective dose response analysis. J Clin Oncol 2016; 34(3): 219–226.
  18. Massabeau C, Marchand V, Zefkili S et al. Early experience of helical tomotherapy for hepatobiliary radiotherapy. Case Reports Hepatol 2011; 2011: 545267.
  19. Tse RV, Hawkins M, Lockwood G et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2008; 26(4): 657–664.
  20. Momm F, Schubert E, Henne K et al. Stereotactic fractionated radiotherapy for Klatskin tumours. Radiother Oncol 2010; 95(1): 99–102.
  21. Kaiser GM, Frühauf NR, Lang H et al. Impact of intraoperative radiotherapy (IORT) on survival of patients with unresectable hilar cholangiocarcinoma. Hepatogastroenterology 2008; 55(88): 1951–1954.
  22. Monson JR, Donohue JH, Gunderson LL et al. Intraoperative radiotherapy for unresectable cholangiocarcinoma – the Mayo Clinic experience. Surg Oncol 1992; 1(4): 283–290.
  23. Mattiucci GC, Autorino R, D’Agostino GR et al. Chemoradiation and brachytherapy in extrahepatic bile duct carcinoma. Crit Rev Oncol Hematol 2014; 90(1): 58–67.
  24. Skowronek J, Zwierzchowski G. Brachytherapy in the treatment of bile duct cancer - a tough challenge. J Contemp Brachytherapy 2017; 9(2): 187–195.
  25. Xu X, Li J, Wu J et al. A systematic review and meta-analysis of intraluminal brachytherapy versus stent alone in the treatment of malignant obstructive jaundice. Cardiovasc Intervent Radiol 2018; 41(2): 206–217.
  26. Shinohara ET, Guo M, Mitra N, Metz JM. Brachytherapy in the treatment of cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2010; 78(3): 722–728.
  27. Yoshioka Y, Ogawa K, Oikawa H et al. Impact of intraluminal brachytherapy on survival outcome for radiation therapy for unresectable biliary tract cancer: a propensity-score matched-pair analysis. Int J Radiat Oncol Biol Phys 2014; 89(4): 822–829.
  28. Andrašina T, Válek V, Pánek J et al. Multimodal oncological therapy comprising stents, brachytherapy, and regional chemotherapy for cholangiocarcinoma. Gut Liver 2010; 4(Suppl. 1): 82–88.
  29. Valle J, Wasan H, Palmer DH et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362(14): 1273–1281.
  30. Zhuang X, Xiao YP, Tan LH et al. Efficacy and safety of chemotherapy with or without targeted therapy in biliary tract cancer: A meta-analysis of 7 randomized controlled trials. J Huazhong Univ Sci Technolog Med Sci 2017; 37(2): 172–178.
  31. Kelley RK. Advances in molecular targeted therapies in cholangiocarcinoma. Invited lecture. Gastrointestinal Cancers Symposium, San Francisco, 19. 1. 2018.
  32. Diaz L, Marabelle A, Kim TW et al. Efficacy of pembrolizumab in phase 2 KEYNOTE-164 and KEYNOTE-158 studies of microsatellite instability high cancers. ESMO Congress 2017, abstract 386P.
  33. Jusakul A, Cutcutache I, Yong CH et al. Whole-genome and epigenomic landscapes of etiologically distinct subtypes of cholangiocarcinoma. Cancer Disc 2017; 7: 1116–1135.
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