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Cholangiocarcinoma AND unresectability AND CT

Silvia Bisello, Matteo Renzulli, Milly Buwenge, Lucia Calculli, Giuseppina Sallustio, Gabriella Macchia, Francesco Deodato, Giancarlo Mattiucci, Silvia Cammelli, Alessandra Arcelli, Lucia Giaccherini, Francesco Cellini, Giovanni Brandi, Sara Guerri, Savino Cilla, Rita Golfieri, Lorenzo Fuccio, Alessio G Morganti, Alessandra Guido
Radiotherapy (RT) is a treatment option for advanced biliary tract cancer (BTC), often combined with sequential and/or concurrent chemotherapy. The use of modern RT techniques requires accurate clinical target volume (CTV) definition and delineation. However, guidelines for CTV delineation in BTC are lacking. Therefore, the aim of this study was to propose a computer tomography (CT) atlas for CTV definition of BTC. We previously proposed guidelines to define the nodal CTV (CTV-N) in BTC. In this study, based on a literature analysis, we defined the margins to be added to the gross tumor volume (GTV; subclinical and microscopic disease) to define the primary tumor CTV (CTV-T)...
February 2019: Oncology Letters
Li-Ye Wang, Shuai Gong, Li-Ping Gao, Li-Xia Hou, Wei He
RATIONALE: Intrahepatic cholangiocarcinoma (ICC) originates from the secondary branch of the bile duct and the intrahepatic bile duct epithelial cells, and is a rare pathological type of primary liver cancer. Recently, apatinib has been successfully used for a variety of malignancies. PATIENT CONCERNS: A 23-year-old female was noted with intermittent right upper abdominal distension, abdominal pain, and vomiting after eating for more than 1 month. The enhanced CT scan revealed multiple intrahepatic lesions, portal vein and right branch tumor emboli were present...
December 2018: Medicine (Baltimore)
Edward C Lo, Adam N Rucker, Michael P Federle
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) comprise the majority of primary liver cancers. Both HCC and ICC have characteristic imaging appearances on multiphase computed tomography (CT) and magnetic resonance imaging (MRI). Several locoregional therapies, including radiation therapy, are used to treat unresectable disease and residual or recurrent tumor. The tumor response following locoregional therapies has variable imaging manifestations. Focal liver reaction, the imaging changes of the liver following radiation treatment, should be recognized and not mistaken for tumor...
October 2018: Seminars in Radiation Oncology
Wei-Wen Chang, Ping-Kun Hsiao, Lei Qin, Chia-Lun Chang, Jyh-Ming Chow, Szu-Yuan Wu
PURPOSE: No prospective randomized trials have been conducted to date to evaluate the efficacy of palliation of pain or jaundice without treatment, definitive concurrent chemoradiotherapy (CCRT), sequential chemotherapy and radiotherapy (CTRT), or chemotherapy (CT) alone for treating unresectable intrahepatic cholangiocarcinoma (ICC). We designed a nationwide, population-based, cohort study to determine the effects of different treatments on patients with unresectable ICC using propensity score matching (PSM) with the Mahalanobis metric...
November 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Riccardo Aurelio Nasto, Paolo Tarantino, Raffaele Fristachi, Luigi Cacace, Sara Bortone
AIM: We evaluated feasibility, safety and efficacy of Electrochemotherapy (ECT) in a prospective series of patients with unresectable Perihilar-Cholangiocarcinoma (PHCCA). PATIENTS AND METHODS: Five patients with PHCCA underwent ECT. Three patients underwent percutaneous ECT of a single PHCCA nodule. One patient underwent resection of a nodule in the IV segment and intraoperative ECT of a large PHCCA in the VIII segment. Another patient underwent percutaneous ECT of a large PHCCA recurrence after left lobectomy and RF ablation of a synchronous metastasis in the VI segment...
October 2018: European Journal of Surgical Oncology
Vivek Verma, Adams Kusi Appiah, Tim Lautenschlaeger, Sebastian Adeberg, Charles B Simone, Chi Lin
Background: Current guidelines recommend chemotherapy (CT) with or without radiotherapy (RT) for unresected intrahepatic cholangiocarcinoma (IC). Although there is currently lack of consensus, previous smaller studies have illustrated the efficacy of local therapy for this population. This investigation evaluated outcomes of chemoradiotherapy (CRT) versus CT alone in unresected IC using a large, contemporary national database. Methods: The National Cancer Data Base (NCDB) was queried for primary IC cases (2004-2013) receiving CT alone or CRT...
June 2018: Journal of Gastrointestinal Oncology
Xuling Li, Ying Zhang, Yongyang Zhang
BACKGROUND: As the most common cholangiocarcinoma, hilar cholangiocarcinoma (HCCA) is a challenge in hepatobiliary surgery and causes a very poor prognosis. This study was designed to explore whether 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) may be a suitable method for preoperative diagnosis and evaluation of Chinese older patients with hilar cholangiocarcinoma. METHODS: This study enrolled 53 patients (≥ 65 years) with HCCA...
July 6, 2018: BMC Geriatrics
Luca Filippi, Annamaria Lacanfora, Roberto Cianni, Orazio Schillaci, Oreste Bagni
We present a case of a 42-year-old male patient affected by unresectable, chemorefractory cholangiocarcinoma, with prior placement of biliary stent. Because of the absence of extrahepatic metastases, he was submitted to liver-direct therapy with 90 Y-microspheres. 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) performed before the procedure showed intense tracer uptake in the hepatic lesion and along the biliary stent. The patient underwent radioembolization with 90 Y-resin spheres (1...
July 2018: Indian Journal of Nuclear Medicine: IJNM: the Official Journal of the Society of Nuclear Medicine, India
Ko Sugiyama, Toshiya Kamiyama, Takumi Ohmura, Akihisa Nagatsu, Shingo Shimada, Takahiro Einama, Kenji Wakayama, Tatsuya Orimo, Hideki Yokoo, Hirofumi Kamachi, Akinobu Taketomi
The patient was a 63-year-old man. Computed tomography(CT)showed a 99mm in diameter low-density mass in hepatic segments 4 and 8 as the main locus. This tumor was diagnosed as intrahepatic cholangiocarcinoma and was suspected to invade to left and right Gleason's sheath, and radical cure was judged impossible. After hepatic arterial chemotherapy and radiotherapy were performed, tumor shrinkage was confirmed, and tumor markers also became negative. So he was referred to our hospital for surgical indication. CT revealed that the tumor did not invade to the left Gleason's sheath...
April 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Thana Boonsinsukh, Vichit Viriyaroj, Thammanij Rookkachart, Therdkiat Trongwongsa
The authors report a case of a patient with intrahepatic sarcomatous cholangiocarcinoma. A 45-year-old Thai man presented with a 3-month history of right upper abdominal pain. CT scan revealed hepatomegaly with a 6.5 cm hypovascular soft tissue density mass in the right lobe and showed mild delayed enhancement. On exploratory laparotomy, the tumor adherent to right diaphragm was found. We performed right hepatectomy, partial resection of right diaphragm, and cholecystectomy. The immunohistological results suggested "sarcomatous intrahepatic cholangiocarcinoma...
2018: Case Reports in Surgery
Yusuke Okubo, Takeshi Tono, Yasuhito Kawasaki, Takaaki Ishii, Hisashi Hara, Shuho Senba, Seiji Yasuda, Minoru Otsuru
The patient was a woman in her 50's. She went to the hospitalfor epigastric discomfort. Numerous hypovascular tumors spreading almost to the entire liver were detected via abdominal CT. We diagnosed the tumors as unresectable intrahepatic cholangiocarcinoma(ICC). Chemotherapy with gemcitabine(GEM)and S-1 was given. The tumors shrunk markedly, and stable disease status was maintained for 2 years and 4 months. Thereafter, the regimen was changed to GEM plus cisplatin (CDDP)because of progressive disease, which was then uncontrolled...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Anna Torgeson, Shane Lloyd, Dustin Boothe, George Cannon, Ignacio Garrido-Laguna, Jonathan Whisenant, Mark Lewis, Robin Kim, Courtney Scaife, Randa Tao
BACKGROUND: Unresected extrahepatic cholangiocarcinoma (uEHCC) remains a deadly disease. Guidelines for uEHCC recommend either chemotherapy alone (CT) or chemoradiotherapy (CRT). This study used the National Cancer Database (NCDB) to compare outcomes for patients treated with CT and those who underwent CRT. METHODS: Patients with initially diagnosed non-metastatic uEHCC from 2004 to 2014 were identified. Using Chi square analysis, patients who underwent CT were compared with those who received CRT...
December 2017: Annals of Surgical Oncology
Praveer Rai, Vinod Kumar, Ram Naval Rao
BACKGROUND: Resection surgery for pancreaticobiliary malignancies carries significant morbidity and mortality. Hence, preoperative assessment to exclude unresectable disease is mandatory. CT abdomen is the primary modality for staging of pancreaticobiliary cancers. However, some patients have malignant mediastinal lymphadenopathy (MML), which may be detected on endoscopic ultrasound (EUS) but not on CT scan. METHODS: We prospectively evaluated 75 consecutive patients (median age 54 years: 44 men) with a diagnosis of resectable pancreaticobiliary cancer (carcinoma gallbladder, carcinoma pancreas, cholangiocarcinoma, or periampullary carcinoma) for the presence of MML using EUS by an experienced endosonographer...
May 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Stefan Buettner, Ana Wilson, Georgios Antonis Margonis, Faiz Gani, Cecilia G Ethun, George A Poultsides, Thuy Tran, Kamran Idrees, Chelsea A Isom, Ryan C Fields, Bradley Krasnick, Sharon M Weber, Ahmed Salem, Robert C G Martin, Charles R Scoggins, Perry Shen, Harveshp D Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras, Rivfka Shenoy, Shishir K Maithel, Timothy M Pawlik
INTRODUCTION: Extrahepatic biliary malignancies are often diagnosed at an advanced stage. We compared patients with unresectable perihilar cholangiocarcinoma (PHCC) and gallbladder cancer (GBC) who underwent a palliative procedure versus an aborted laparotomy. METHODS: Seven hundred seventy-seven patients who underwent surgery for PHCC or GBC between 2000 and 2014 were identified. Uni- and multivariable analyses were performed to identify factors associated with outcome...
August 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Edward M Marchan, Jerome C Landry
BACKGROUND: Cholangiocarcinoma (CCA) is a bile duct tumor with a grim prognosis. The median survival after radiotherapy of unresectable disease is 9-12 months. The following is a review of our experience with neoadjuvant (NEO) chemoradiation followed by orthotopic liver transplantation (OLT) for CCA. METHODS: Ten patients with CCAs were selected as candidates for NEO-OLT between 2008-2011. Patients with unresectable CCA above the cystic duct without intra or extrahepatic metastases were eligible...
April 2016: Journal of Gastrointestinal Oncology
Ricarda Seidensticker, Max Seidensticker, Kathleen Doegen, Konrad Mohnike, Kerstin Schütte, Patrick Stübs, Erika Kettner, Maciej Pech, Holger Amthauer, Jens Ricke
Aim. To assess the outcomes of patients with unresectable intrahepatic cholangiocellular carcinoma (ICC) treated by a tailored therapeutic approach, combining systemic with advanced image-guided local or locoregional therapies. Materials and Methods. Treatment followed an algorithm established by a multidisciplinary GI-tumor team. Treatment options comprised ablation (RFA, CT-guided brachytherapy) or locoregional techniques (TACE, radioembolization, i.a. chemotherapy). Results. Median survival was 33.1 months from time of diagnosis and 16...
2016: Gastroenterology Research and Practice
Giovanni Brandi, Michela Venturi, Maria Abbondanza Pantaleo, Giorgio Ercolani
In the oncology landscape, cholangiocarcinoma is a challenging disease in terms of both diagnosis and treatment. Besides anamnesis and clinical examination, a definitive diagnosis of cholangiocarcinoma should be supported by imaging techniques (US, CT, MRI) and invasive investigations (ERC or EUS with brushing and FNA or US or CT-guided biopsy) followed by pathological confirmation. Surgery is the main curative option, so resectability of the tumour should be promptly assessed. Moreover, jaundice must be evaluated at the outset because biliary tract decompression with drainage and stent placement may be required...
March 2016: Digestive and Liver Disease
Marco Massani, Cristina Nistri, Cesare Ruffolo, Roberta Bonariol, Bruno Pauletti, Luca Bonariol, Ezio Caratozzolo, Giovanni Morana, Nicolò Bassi
Most patients with intrahepatic cholangiocarcinoma (IH-CCA) are unresectable and treatment options are limited. This study evaluates the efficacy of hepatic artery infusion (HAI) chemotherapy in patients whose disease is not initially treatable with resection. We selected patients with unresectable IH-CCA treated only with HAI chemotherapy at our centre between January 2008 and December 2012. We compared our outcome, using mRECIST, with published results of patients treated with systemic chemotherapy during the same period...
December 2015: Updates in Surgery
Katie E Rollins, Nilanjana Tewari, Abigail Ackner, Amir Awwad, Srinivasan Madhusudan, Ian A Macdonald, Kenneth C H Fearon, Dileep N Lobo
BACKGROUND & AIMS: Patients with pancreatic cancer have a poor prognosis, are often cachectic, and frequently demonstrate features of systemic inflammation, which may contribute to the phenomenon of myosteatosis. Analysis of body composition from CT scans has been used to study sarcopenia and its association with prognosis in a number of types of cancer, particular in combination with obesity. It has also been suggested that myosteatosis, defined as attenuated mean skeletal muscle Hounsfield units (HU), is associated with reduced survival in cancer...
October 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Jens M Theysohn, Marcus Ruhlmann, Stefan Müller, Alexander Dechene, Jan Best, Johannes Haubold, Lale Umutlu, Guido Gerken, Andreas Bockisch, Thomas C Lauenstein
PURPOSE: Selective Internal Radiation Therapy (SIRT) with 90yttrium (Y-90) is an increasingly used therapeutic option for unresectable liver malignancies. Nontarget embolization of extrahepatic tissue secondary to vascular shunting can lead to SIRT associated complications. Our aim was to assess whether extrahepatic shunts can reliably be diagnosed based on hepatic digital subtraction angiography (DSA) or whether subsequent SPECT/CT data can provide additional information. MATERIALS AND METHODS: 825 patients with hepatocellular carcinoma (n = 636), hepatic metastases (n = 158) or cholangiocellular carcinoma (n = 31) were retrospectively analyzed...
2015: PloS One
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