Biliary tract tumors: past, present and future
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Tumors of the biliary tract (gallbladder tumors, cholangiocarcinomas and ampullary carcinomas) are low incidence tumors with poor prognosis. The five-year overall survival is 50% for stage I, 30% stage II, 10% stage III and 0% stage IV. Treatment is based on surgery for potentially resectable tumors. Chemotherapy and chemo-radiotherapy is the treatment of choice when surgery is not amenable, however it has not achieved encouraging results. These patients use to have very few symptoms, which is the reason for the delay in diagnosis and the poor prognosis. They frequently develop biliary obstruction: obstructive jaundice, right upper quadrant pain and weight loss. Ampullary carcinomas are frequently related to steatorrhea due to malabsorption. The most effective chemotherapy drugs used in monotherapy are 5FU (response rate 20%) and gemcitabine (response rate of 13%–60%), so they have been selected for further development in multiple phase II clinical trials to explore their efficacy and safety in combination with other agents. In a phase III clinical trial, combination of gemcitabine and cisplatin has been selected as the schedule of choice. Target therapies are also being developed in this malignancy. The present work reviews the most current knowledge of the pathogenesis, diagnosis and natural history of biliary tract tumors. Further, review of surgery, current adjuvant treatment and therapies for unresectable and advanced disease is provided. The most recent understanding for target therapies and molecular biology is also summarized.
Key wordsbiliary tract tumors chemotherapy surgery radiotherapy target therapies
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- 2.Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th Ed. Springer-Verlag. 2010.Google Scholar
- 3.Henson DE, Albores-Saavedra J, Corle D. Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer, 1992, 70: 1493–1497.Google Scholar
- 11.Rajagopalan V, Daines WP, Grossbard ML, et al. Gallbladder and biliary tract carcinoma: A comprehensive update, Part 1. Oncology (Williston Park), 2004, 18: 889–896.Google Scholar
- 17.Borghero Y, Crane CH, Szklaruk J, et al. Extrahepatic bile duct adenocarcinoma: patients at high-risk for local recurrence treated with surgery and adjuvant chemoradiation have an equivalent overall survival to patients with standard-risk treated with surgery alone. Ann Surg Oncol, 2008, 15: 3147–3156.PubMedCrossRefGoogle Scholar
- 38.Gebbia V, Giuliani F, Maiello E, et al. Treatment of inoperable and/or metastatic biliary tree carcinomas with single-agent gemcitabine or in combination with levofolinic acid and infusional fluorouracil: results of a multicenter phase II study. J Clin Oncol, 2001, 19: 4089–4091.PubMedGoogle Scholar
- 41.Bhargava P, Jani CR, Savarese DM, et al. Gemcitabine and irinotecan in locally advanced or metastatic biliary cancer: preliminary report. Oncology (Williston Park), 2003, 17: 23–26.Google Scholar
- 47.Bridgewater JA, Palmer D, Cunningham D, et al. Second-line therapy in advanced biliary tract cancer: baseline data from retrospective multicenter series. Ann Oncol, 2012, 23: 224–257.Google Scholar
- 48.Malka D, Trarbach T, Fartoux L, et al. A multicenter, randomized phase II trial of gemcitabine and oxaliplatin (GEMOX) alone or in combination with biweekly cetuximab in the first-line treatment of advanced biliary cancer: Interim analysis of the BINGO trial. ASCO Annual Meeting Proceedings (Post-Meeting Edition). J Clin Oncol, 2009, 27: 4520.Google Scholar
- 55.El-Khoueiry AB, Rankin C, Lenz HJ, et al. SWOG 0514: A phase II study of sorafenib (BAY 43-9006) as single agent in patients (pts) with unresectable or metastatic gallbladder cancer or cholangiocarcinomas. ASCO Annual Meeting Proceedings Part I. J Clin Oncol, 2007, 25: 4639.Google Scholar