| Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers. | |
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MedLine Citation:
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PMID: 22504095 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND & AIMS: Excellent single-center outcomes of neoadjuvant chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma caused the United Network of Organ Sharing to offer a standardized model of end-stage liver disease (MELD) exception for this disease. We analyzed data from multiple centers to determine the effectiveness of this treatment and the appropriateness of the MELD exception. METHODS: We collected and analyzed data from 12 large-volume transplant centers in the United States. These centers met the inclusion criteria of treating 3 or more patients with perihilar cholangiocarcinoma using neoadjuvant therapy, followed by liver transplantation, from 1993 to 2010 (n = 287 total patients). Center-specific protocols and medical charts were reviewed on-site. RESULTS: The patients completed external radiation (99%), brachytherapy (75%), radiosensitizing therapy (98%), and/or maintenance chemotherapy (65%). Seventy-one patients dropped out before liver transplantation (rate, 11.5% in 3 months). Intent-to-treat survival rates were 68% and 53%, 2 and 5 years after therapy, respectively; post-transplant, recurrence-free survival rates were 78% and 65%, respectively. Patients outside the United Network of Organ Sharing criteria (those with tumor mass >3 cm, transperitoneal tumor biopsy, or metastatic disease) or with a prior malignancy had significantly shorter survival times (P < .001). There were no differences in outcomes among patients based on differences in surgical staging or brachytherapy. Although most patients came from 1 center (n = 193), the other 11 centers had similar survival times after therapy. CONCLUSIONS: Patients with perihilar cholangiocarcinoma who were treated with neoadjuvant therapy followed up by liver transplantation at 12 US centers had a 65% rate of recurrence-free survival after 5 years, showing this therapy to be highly effective. An 11.5% drop-out rate after 3.5 months of therapy indicates the appropriateness of the MELD exception. Rigorous selection is important for the continued success of this treatment. |
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Authors:
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Sarwa Darwish Murad; W Ray Kim; Denise M Harnois; David D Douglas; James Burton; Laura M Kulik; Jean F Botha; Joshua D Mezrich; William C Chapman; Jason J Schwartz; Johnny C Hong; Jean C Emond; Hoonbae Jeon; Charles B Rosen; Gregory J Gores; Julie K Heimbach |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2012-04-12 |
Journal Detail:
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Title: Gastroenterology Volume: 143 ISSN: 1528-0012 ISO Abbreviation: Gastroenterology Publication Date: 2012 Jul |
Date Detail:
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Created Date: 2012-06-26 Completed Date: 2012-10-01 Revised Date: 2013-02-25 |
Medline Journal Info:
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Nlm Unique ID: 0374630 Medline TA: Gastroenterology Country: United States |
Other Details:
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Languages: eng Pagination: 88-98.e3; quiz e14 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Bile Duct Neoplasms / therapy* Bile Ducts, Intrahepatic* Chemoradiotherapy* Cholangiocarcinoma / therapy* Female Humans Liver Transplantation* Male Middle Aged Neoadjuvant Therapy Retrospective Studies Treatment Outcome United States Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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UL1 RR025011/RR/NCRR NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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