Liver Transplantation with Neoadjuvant Chemoradiation is More Effective than Resection for Hilar Cholangiocarcinoma

494 Background: Our aim was to compare survival between patients receiving neoadjuvant chemoradiation and orthotopic liver transplantation (OLT group) versus definitive chemoradiation (CRT group) for extrahepatic or hilar cholangiocarcinoma. Methods: 49 patients (20 in OLT group vs. 29 in CRT group) with unresectable hilar/extrahepatic cholangiocarcinoma were treated at Mayo Clinic Arizona between Feb. 1998–Sep. 2019. Treatment included external beam radiation therapy (median 4500cGy) and boost (median 900cGy) with either continuous 5-flurouracil (dose range 180–225 mg/m2) or capecitabine (dose range 825–1000 mg/m2 BID) prior to or without OLT. Radiation boosts were delivered with EBRT or bile duct brachytherapy. Patients were between 27.9–84.3 years (median 64.3) at diagnosis. 18 patients had previous diagnosis of PSC. Results: Between Feb. 1998–Sep. 2019, 31(63%) of 49 patients died by the end of follow-up. Of patients treated with neoadjuvant therapy and OLT, 7(35%) of 20 patients died. 24(86%) of 28 patients treated with definitive therapy died. The OLT cohort were younger (mean age 56.5 vs. 69.0 years), more likely to have PSC and UC (65% vs. 17%), and had a lower CA 19-9 (median 43 vs. 535)(P < 0.003). From the end date of radiation, median overall survival was 76.8 months vs. 15.6 months for the OLT and CRT groups, respectively. Survival rates at 3 and 5 years were 78% and 69% in the OLT group compared to 19% and 6% in the CRT group (HR 7.73; 3.04-19.65:(P < 0.0001)). Progression-free survival (89% vs. 30% at 3 years), and distant metastasis-free survival (88% vs. 66% at 3 years) favored OLT versus CRT alone (HR 5.74;1.12-29.34:(P < 0.02)). Univariate analysis demonstrated that the method of treatment (OLT vs. CRT) was the only variable associated with better clinical outcomes. Conclusions: In patients with unresectable extrahepatic/hilar cholangiocarcinoma, survival was higher in those who underwent chemoradiation and OLT. Patients who received definitive chemoradiation in the absence of OLT were expected to have worse overall, progression-free, and metastasis-free survival.

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Liver Transplantation With Neoadjuvant Chemoradiation Is More Effective Than Resection for Hilar Cholangiocarcinoma

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(08)70402-1 ◽

2006 ◽

Vol 2006 ◽

pp. 218-219

Author(s):

J.A. Drebin

Keyword(s):

Liver Transplantation ◽

Hilar Cholangiocarcinoma ◽

Neoadjuvant Chemoradiation

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LIVER TRANSPLANTATION WITH NEOADJUVANT CHEMORADIATION FOR TREATMENT OF UNRESECTABLE HILAR CHOLANGIOCARCINOMA. AN EUROPEAN SERIES.

Transplantation Journal ◽

10.1097/01.tp.0000701296.73145.64 ◽

2020 ◽

Vol 104 (S3) ◽

pp. S519-S519

Author(s):

Cristina Dopazo ◽

Laura Llado ◽

Amelia Hessheimer ◽

Fondevila Constantino ◽

Macarulla Teresa ◽

...

Keyword(s):

Liver Transplantation ◽

Hilar Cholangiocarcinoma ◽

Neoadjuvant Chemoradiation

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O37: SYSTEMATIC REVIEW AND PROPORTIONAL META-ANALYSIS OF SURVIVAL FOLLOWING NEOADJUVANT CHEMORADIATION AND LIVER TRANSPLANTATION IN UNRESECTABLE HILAR CHOLANGIOCARCINOMA

British Journal of Surgery ◽

10.1093/bjs/znab117.037 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

WA Cambridge ◽

RV Guest

Keyword(s):

Liver Transplantation ◽

Overall Survival ◽

Primary Sclerosing Cholangitis ◽

Hilar Cholangiocarcinoma ◽

Sclerosing Cholangitis ◽

Meta Analysis ◽

Survival Rates ◽

Disease Recurrence ◽

Neoadjuvant Chemoradiation ◽

Overall Survival Rates

Abstract Introduction Despite improvements in survival for other tumour types, the prognosis of hilar cholangiocarcinoma (CC) continues to be extremely poor. Since publication of the Mayo protocol in 2000, an increasing number of case series around the world have reported excellent outcomes after neoadjuvant chemoradiation followed by liver transplantation (NCR-LT) in unresectable hilar CC. Method MEDLINE, EMBASE, Scopus and Web of Science databases were searched and data extracted from relevant studies. A proportional meta-analysis was conducted to pool 1, 3- and 5-year survival and disease recurrence rates following NCR-LT. Result Twenty studies comprising 428 patients were eligible for final analysis. The pooled 1, 3- and 5-year overall survival rates following LT without neoadjuvant therapy were 71.2% (95% CI 62.2 - 79.4), 48.0% (95% CI 35.0 - 60.9) and 31.6% (95% CI 23.1 - 40.7). These rates improved to 82.8% (95% CI 73.0 - 90.8), 65.5% (95% CI 48.7 - 80.5) and 65.1% (95% CI 55.1 - 74.5) following administration of a neoadjuvant chemoradiation protocol. The pooled recurrence rate was 51.7% (95% CI 33.8 - 69.4) in patients who did not undergo neoadjuvant treatment and 24.1% (95% CI 17.9 - 30.9) in those who did. Conclusion In unresectable hilar CC, NCR-LT confers long-term survival in selected patients able to complete neoadjuvant chemoradiation followed by transplantation. Patients with primary sclerosing cholangitis have the most favourable survival outcomes. A high disease recurrence rate is of concern when considering extending national graft allocation schemes. CC - Cholangiocarcinoma, NCR-LT - Neoadjuvant Chemoradiation & Liver Transplantation Take-home message In selected patients, the treatment of unresectable hilar cholangiocarcinoma with neoadjuvant chemoradiation and liver transplantation results in 5-year overall survival rates greater than 50%. Patients with hilar cholangiocarcinoma and concomitant primary sclerosing cholangitis have the most favourable outcomes post-transplantation.

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