Langenbeck's Archives of Surgery

, Volume 399, Issue 6, pp 679–692 | Cite as

Multimodal treatment strategies for advanced hilar cholangiocarcinoma

  • Matthew J. Weiss
  • David Cosgrove
  • Joseph M. Herman
  • Neda Rastegar
  • Ihab Kamel
  • Timothy M. Pawlik
Review Article

Abstract

Cholangiocarcinoma (CCA) is the second most common primary malignancy of the liver arising from malignant transformation and growth of biliary ductal epithelium. Approximately 50–70 % of CCAs arise at the hilar plate of the biliary tree, which are termed hilar cholangiocarcinoma (HC). Various staging systems are currently employed to classify HCs and determine resectability. Depending on the pre-operative staging, the mainstays of treatment include surgery, chemotherapy, radiation therapy, and photodynamic therapy. Surgical resection offers the only chance for cure of HC and achieving an R0 resection has demonstrated improved overall survival. However, obtaining longitudinal and radial surgical margins that are free of tumor can be difficult and frequently requires extensive resections, particularly for advanced HCs. Pre-operative interventions may be necessary to prepare patients for major hepatic resections, including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and portal vein embolization. Multimodal therapy that combines chemotherapy with external beam radiation, stereotactic body radiation therapy, bile duct brachytherapy, and/or photodynamic therapy are all possible strategies for advanced HC prior to resection. Orthotopic liver transplantation is another therapeutic option that can achieve complete extirpation of locally advanced HC in judiciously selected patients following standardized neoadjuvant protocols.

Keywords

Cholangiocarcinoma Hilar Biliary neoplasm Multimodal treatment 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Matthew J. Weiss
    • 1
  • David Cosgrove
    • 2
  • Joseph M. Herman
    • 3
  • Neda Rastegar
    • 4
  • Ihab Kamel
    • 4
  • Timothy M. Pawlik
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Medical OncologyThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.Department of Radiation OncologyThe Johns Hopkins HospitalBaltimoreUSA
  4. 4.Department of RadiologyThe Johns Hopkins HospitalBaltimoreUSA

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