Publication details

Hilar cholangiocarcinoma: palliation strategies



Year of publication 2015
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Description Tumours located in the hilar region often infiltrate early and encircle the vascular system (the branches of the common hepatic artery and portal vein), and cholangiocarcinomas also expand longitudinally into the intra- and extrahepatic bile ducts, submucosally and perineurially.The effect of systemic chemotherapy alone in the treatment of non-resectable cholangiocarcinomas is very limited. Stent implantation is an optimal solution for malignant obstructions in patients who are not candidates for surgical intervention and where the expected survival is longer than 3–6 months. IThe most frequent complication of SEMS is their closure. The stent gradually becomes covered with bile duct mucosa. In some patients, benign obstruction can occur due to its hyperplasia. Very frequently, stent occlusion is also associated with migration or closure by detritus and sludge formation. As disease progresses, there can occur ingrowth or overgrowth of the stent edge by the tumour. Despite the fact that adenocarcinomas of bile ducts are regarded as tumours with low radiosensitivity, data in the literature supports the use of radiotherapy in palliating tumours at this location.Hilar cholangiocarcinoma remains a complex medical problem. Chemotherapy or combinations of chemo- and radiation therapy can prolong survival, but their results are still far from satisfactory. Survival times can be influenced by optimal drainage, brachytherapy, photodynamic therapy, or other ablation treatments. In view of its morphological diversity, relatively low incidence, and high patient age, it is very difficult to create a sufficiently homogenous set of patients to demonstrate the effectiveness of the individual therapeutic methods or combinations. It seems that in highly selected patient groups, very good prognoses can be achieved, while in a part of the patients, all therapeutic methods either fail or cannot be fully used due to patients’ status or unavailability of the necessary technology.

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