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Neoadjuvant and Adjuvant Therapy for Cholangiocarcinoma

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Diagnosis and Management of Cholangiocarcinoma

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Abstract

Cholangiocarcinoma is an epithelial-based malignancy that is often described by its location of origin within the biliary tree. Curative-intent treatment is based upon patient fitness, extent of disease, absence of metastatic disease, and, when liver resection is required, anticipated amount of liver parenchyma remaining. Systemic and regional therapies are often required in the treatment of cholangiocarcinoma and can be employed in a neoadjuvant or adjuvant fashion. While cytotoxic chemotherapy has traditionally been studied in the adjuvant setting, the optimal treatment regimen, role of radiotherapy, and use of targeted therapies remain topics of investigation. Neoadjuvant therapy, traditionally reserved for borderline-resectable or oncologically high-risk disease, continues to be studied in these patients as well as in patients otherwise suited for up-front resection. As with evolving treatment regimens, patient selection and prognostic factors are increasingly studied through use of national and multi-institutional databases to enhance the multidisciplinary approach required for treatment of cholangiocarcinoma.

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Abbreviations

5-FU:

5-fluorouracil

ASCO:

American Society of Clinical Oncology

ASCOT:

Adjuvant S1 for Cholangiocarcinoma Trial

BCAT:

Biliary Cancer Adjuvant Trial

BILCAP:

Capecitabine compared with observation in resected biliary tract cancer

CCA:

Cholangiocarcinoma

dCCA:

Distal cholangiocarcinoma

DFS:

Disease-free survival

EBRT:

External beam radiation therapy

EGFR:

Epidermal growth factor receptor

ESPAC:

European Study Group for Pancreatic Cancer

FGFR:

Fibroblast growth factor receptor

GAP:

Gemcitabine, cisplatin, and albumin-bound (nab)-paclitaxel

HAI:

Hepatic artery infusion

HARE:

Hepatic artery radioembolization

IDH:

Isocitrate dehydrogenase

JCOG:

Japanese Clinical Oncology Group

LDLT:

Living donor liver transplant

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

NCCN:

National Comprehensive Cancer Network

NLR:

Neutrophil to lymphocyte ratio

OLT:

Orthotopic liver transplantation

OS:

Overall survival

pCCA:

Perihilar cholangiocarcinoma

PD:

Pancreaticoduodenectomy

RFS:

Recurrence-free survival

SIRT:

Selective internal radiation therapy

SWOG:

Southwest Oncology Group

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    Russell C. Kirks & Flavio G. Rocha

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  1. Russell C. Kirks
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Correspondence to Flavio G. Rocha .

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  1. Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA

    James H. Tabibian

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Kirks, R.C., Rocha, F.G. (2021). Neoadjuvant and Adjuvant Therapy for Cholangiocarcinoma. In: Tabibian, J.H. (eds) Diagnosis and Management of Cholangiocarcinoma. Springer, Cham. https://doi.org/10.1007/978-3-030-70936-5_16

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