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Rizzo A, Brandi G. Pitfalls, challenges, and updates in adjuvant systemic treatment for resected biliary tract cancer. Expert Rev Gastroenterol Hepatol 2021; 15:547-554. [PMID: 33571059 DOI: 10.1080/17474124.2021.1890031] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Unfortunately, potentially curative surgical resection is possible in approximately the 25% of biliary tract cancer (BTC) patients at diagnosis, and even following radical surgery, relapse rates remain high. Thus, the role of adjuvant systemic treatment has been widely explored in this setting over the last decades, with the hope of lowering recurrence rates and improving outcomes of BTC patients.Areas covered: In this review, we provide an overview of available evidence regarding adjuvant systemic therapy in resected BTC, critically discussing the pros and cons of recently published clinical trials such as the BILCAP, the BCAT, and the PRODIGE-12/ACCORD-18 phase III studies.Expert opinion: Although the BILCAP trial has established adjuvant capecitabine for 6 months following radical resection as a novel standard of care, the role of adjuvant systemic chemotherapy is the object of debate and controversy in the BTC medical community. Although most of the international guidelines on BTC management have not yet been updated, the recently published ASCO guidelines support the use of capecitabine in this setting. Several phase I to III clinical trials are currently evaluating the role of novel therapeutic approaches in patients with resected BTC, and the results of these studies are highly awaited.
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Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Toyonaga H, Hayashi T, Ueki H, Chikugo K, Ishii T, Nasuno H, Kin T, Takahashi K, Takada M, Ambo Y, Shinohara T, Yamazaki H, Katanuma A. An intact boundary between the tumor and inner hypoechoic layer discriminates T1 lesions among sessile elevated gallbladder cancers. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:1121-1129. [PMID: 33826798 DOI: 10.1002/jhbp.961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/06/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The depth of invasion determines the surgical method for treating gallbladder cancer (GBC). However, the preoperative correct diagnosis of invasion depth, especially discrimination of T1 lesions among sessile elevated GBCs, is difficult. We investigated the utility of preoperative endoscopic ultrasound (EUS) findings for diagnosing the invasion depth. METHODS We studied a sessile elevated GBC specimen diagnosed as a T1 lesion before developing our study protocol. EUS evidenced an intact boundary between the tumor and the inner hypoechoic layer (the intact boundary sign). To evaluate the potential of using this sign to diagnose T1 GBC as a primary outcome indicator, we retrospectively analyzed patients who underwent surgical resection of sessile elevated GBCs between April 2009 and March 2020. RESULTS Of the 26 surgically resected sessile elevated GBC specimens, 20 were included and six were excluded due to difficulty in evaluating the overall tumor or layer structure. The Kappa coefficient for interobserver agreement regarding the intact boundary sign was 0.733. The sensitivity and specificity of the sign for diagnosing T1 lesions were 0.857 and 1.000, respectively. CONCLUSION This new EUS finding could guide the accurate diagnosis of T1 lesions in patients with sessile elevated GBC.
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Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hidetaro Ueki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kouki Chikugo
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hiroshi Nasuno
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Hajime Yamazaki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
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Adjuvant systemic treatment in resected biliary tract cancer: State of the art, controversies, and future directions. Cancer Treat Res Commun 2021; 27:100334. [PMID: 33592563 DOI: 10.1016/j.ctarc.2021.100334] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 01/04/2023]
Abstract
Biliary tract cancer (BTC) includes a heterogeneous group of aggressive malignancies comprising gallbladder cancer (GBC), ampulla of Vater cancer (AVC), intrahepatic cholangiocarcinoma (iCCA), and extrahepatic cholangiocarcinoma (eCCA). Unfortunately, potentially curative resection is possible in approximately the 25% of presenting patients, and relapse rates are high, with a notable proportion of BTCs experiencing disease recurrence. Recent years have seen the publication of several prospective clinical trials evaluating the role of adjuvant systemic treatments, and among these, the phase III BILCAP study provided evidence supporting the use of capecitabine after radical surgery in BTC patients; in fact, although the study failed to meet its primary endpoint, the capecitabine arm showed improved clinical outcomes in terms of overall survival (pre-planned sensitivity analysis in the intention-to-treat population and in the per-protocol analysis) and relapse-free survival. However, the BILCAP has been widely criticized, with several authors that have not accepted adjuvant capecitabine as novel standard of care. In this review, we summarize current state of the art regarding adjuvant systemic treatment in BTC, highlighting advantages and disadvantages of recent clinical trials, and suggesting new research directions in this setting.
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Gao H, Tian T, Li S, Zhang Y, Fu X, Zheng X, Liu N, Jiang A, Ren M, Zhang X, Liang X, Ruan Z, Geng Z, Yao Y. Efficacy Analysis of Adjuvant Chemotherapy with Gemcitabine Plus Platinum or S-1 in Biliary Tract Carcinoma: A Multi-Center Retrospective Study. Cancer Manag Res 2021; 13:889-898. [PMID: 33542660 PMCID: PMC7853243 DOI: 10.2147/cmar.s290083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Biliary tract cancers (BTCs) have a poor overall prognosis, as patients who underwent curative surgery frequently experience disease recurrence. At present, there is a paucity of well-documented adjuvant chemotherapy regimen. This study aimed to assess whether gemcitabine plus platinum or S-1 adjuvant chemotherapy have different impact on relapse-free survival (RFS). PATIENTS AND METHODS We selected patients undergoing radical biliary tract cancer surgery, pathologically confirmed adenocarcinoma and received gemcitabine plus platinum (cisplatin or oxaliplatin) or S-1 adjuvant chemotherapy from September 2013 to May 2020. The primary study endpoint was RFS. The secondary endpoint was safety. RESULTS Overall 136 patients were enrolled. The median follow-up was 32.3 months and the median RFS was 17.0 months (95% CI 8.9-25.1). The median RFS was 14.1 months (95% CI 6.7-21.5) in gemcitabine plus platinum group and 33.0 months (95% CI 9.3-56.7) in gemcitabine plus S-1 (GS) group, a non-significant difference both in univariate (P=0.092) and in multivariate analysis (P=0.058). Lymph node status (N- vs N+: HR=0.477, 95% CI 0.285-0.799; P=0.005) and chemotherapy cycles (<6 vs 6-8: HR=1.828, 95% CI 1.117-2.993; P=0.016) were independent impact factors for RFS. GS group had lower incidence of adverse reactions. CONCLUSION Compared with gemcitabine plus platinum, GS regimen has a tendency to obtain longer RFS (although there is no statistically significant difference) and less toxic. GS regimen has the potential to be investigated as a standard regimen for adjuvant chemotherapy.
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Affiliation(s)
- Huan Gao
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Tao Tian
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Suoni Li
- Department of Medical Oncology, Tumor Hospital of Shaanxi, Xi’an, People’s Republic of China
| | - Yinbin Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xiao Fu
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xiaoqiang Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Na Liu
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Aimin Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Mengdi Ren
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xiaoni Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xuan Liang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Zhiping Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Zhimin Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Lamarca A, Edeline J, McNamara MG, Hubner RA, Nagino M, Bridgewater J, Primrose J, Valle JW. Current standards and future perspectives in adjuvant treatment for biliary tract cancers. Cancer Treat Rev 2020; 84:101936. [PMID: 31986437 DOI: 10.1016/j.ctrv.2019.101936] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
Biliary tract cancer, including cholangiocarcinoma (CCA) and gallbladder cancer (GBC) are rare tumours with a rising incidence. Prognosis is poor, since most patients are diagnosed with advanced disease. Only ~20% of patients are diagnosed with early-stage disease, suitable for curative surgery. Despite surgery performed with potentially-curative intent, relapse rates are high, with around 60-70% of patients expected to have disease recurrence. Most relapses occur in the form of distant metastases, with a predominance of liver spread. In view of high tumour recurrence, adjuvant strategies have been explored for many years, in the form of radiotherapy, chemo-radiotherapy and chemotherapy. Historically, few randomised trials were available, which included a variety of additional tumours (e.g. pancreatic and ampullary tumours); most evidence relied on phase II and retrospective studies, with no high-quality evidence available to define the real benefit derived from adjuvant strategies. Since 2017, three randomised phase III clinical trials have been reported; all recruited patients with resected biliary tract cancer (CCA and GBC) who were randomised to observation alone, or chemotherapy in the form of gemcitabine (BCAT study; included patients diagnosed with extrahepatic CCA only), gemcitabine and oxaliplatin (PRODIGE-12/ACCORD-18; included patients diagnosed with CCA and GBC) or capecitabine (BILCAP; included patients diagnosed with CCA and GBC). While gemcitabine-based chemotherapy failed to show an impact on patient outcome (relapse-free survival (RFS) or overall survival (OS)), the BILCAP study showed a benefit from adjuvant capecitabine in terms of OS (pre-planned sensitivity analysis in the intention-to-treat population and in the per-protocol analysis), with confirmed benefit in terms of RFS. Based on the BILCAP trial, international guidelines recommend adjuvant capecitabine for a period of six months following potentially curative resection of CCA as the current standard of care for resected CCA and GBC. However, BILCAP failed to show OS benefit in the intention-to-treat (non-sensitivity analysis) population (primary end-point), and this finding, as well as some inconsistencies between studies has been criticised and has led to confusion in the biliary tract cancer medical community. This review summarises the adjuvant field in biliary tract cancer, with evidence before and after 2017, and comparison between the latest randomised phase III studies. Potential explanations are presented for differential findings, and future steps are explored.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Masato Nagino
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - John Bridgewater
- Department of Medical Oncology, UCL Cancer Institute, London, United Kingdom
| | - John Primrose
- Department of Surgery, University of Southampton, Southampton, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Kim BH, Kim SH, Song IS, Chun GS. The appropriate surgical strategy for T1b gallbladder cancer incidentally diagnosed after a simple cholecystectomy. Ann Hepatobiliary Pancreat Surg 2019; 23:327-333. [PMID: 31824997 PMCID: PMC6893052 DOI: 10.14701/ahbps.2019.23.4.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/14/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
Backgrounds/Aims The appropriate surgical treatment was investigated for T1b gallbladder (GB) cancer through a retrospective analysis of the clinical outcomes of patients with incidental T1 GB cancer. Methods Patients with T1 GB cancer who were incidentally diagnosed while undergoing a simple cholecystectomy at Chungnam University Hospital from January 2004 to December 2017 were enrolled. Overall, 39 patients with T1 GB cancer, 17 patients with T1a, and 22 patients with T1b were included. We retrospectively analyzed the patients' clinical and pathologic findings and follow-up results. Results Among the 6490 patients who underwent cholecystectomy during the study period, 165 patients were diagnosed with GB cancer (T1=42 [25.5%]). The risk factor associated with recurrence and cancer-related death in patients with T1 GB cancer was lymphovascular invasion (recurrence, p=0.028; death, p=0.004). In the T1b group, the 5-year disease-free survival (DFS) rate showed a statistical difference between patients with and without lymphovascular invasion (45.7% vs. 83.6%, p=0.048). There was no statistically significant difference in 5-year DFS and overall survival rate between simple cholecystectomy and extended cholecystectomy in T1b GB cancer with lymphovasular invasion (p=0.054 and p=0.091, respectively). Conclusions In incidental T1b GB cancer, extended cholecystectomy was not superior to simple cholecystectomy in terms of the 5-year DFS rate and nor in overall survival rate or recurrence rate, even when lymphovascular invasion was identified after simple cholecystectomy. Therefore, simple cholecystectomy may be recommended as a primary surgical strategy for T1b GB cancer.
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Affiliation(s)
- Byoung-Hyoung Kim
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seok-Hwan Kim
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - In-Sang Song
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gwang-Sik Chun
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Vaeteewoottacharn K, Kariya R, Dana P, Fujikawa S, Matsuda K, Ohkuma K, Kudo E, Kraiklang R, Wongkham C, Wongkham S, Okada S. Inhibition of carbonic anhydrase potentiates bevacizumab treatment in cholangiocarcinoma. Tumour Biol 2016; 37:9023-35. [PMID: 26762407 DOI: 10.1007/s13277-016-4785-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/04/2016] [Indexed: 01/07/2023] Open
Abstract
Cholangiocarcinoma (CCA) is a unique liver cancer subtype with an increasing incidence globally. The lack of specific symptoms and definite diagnostic markers results in a delayed diagnosis and disease progression. Systemic chemotherapy is commonly selected for advanced CCA even though its advantages remain unknown. Targeted therapy, especially anti-vascular endothelial growth factor (VEGF) therapy, is promising for CCA; however, improvements in the therapeutic regimen are necessary to overcome subsequent resistance. We demonstrated VEGF expression was higher in CCA cell lines than in other liver cancer cells. Secreted VEGFs played roles in the induction of peri- and intra-tumoral vascularization. VEGF neutralization by bevacizumab effectively reduced tumor growth, mainly through the suppression of angiogenesis; however, increases in the expression of hypoxia-inducible factor 1α (HIF1α) and HIF1α-responsive genes (such as VEGF, VEGFR1, VEGFR2, carbonic anhydrase (CA) IX and CAXII) indicated the potential for subsequent therapeutic resistance. Supplementation with a carbonic anhydrase inhibitor, acetazolamide, enhanced the anti-CCA effects of bevacizumab. Anti-angiogenesis and anti-proliferation were observed with the combination treatment. These results suggested a novel treatment strategy to overcome anti-angiogenesis resistance and the importance of "induced essentiality" in the treatment of CCA.
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Affiliation(s)
- Kulthida Vaeteewoottacharn
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan.,Department of Biochemistry, Khon Kaen University, Khon Kaen, Thailand.,Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ryusho Kariya
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan
| | - Paweena Dana
- Department of Biochemistry, Khon Kaen University, Khon Kaen, Thailand.,Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawako Fujikawa
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan
| | - Kouki Matsuda
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan
| | - Koichi Ohkuma
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan
| | - Eriko Kudo
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan
| | - Ratthaphol Kraiklang
- Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Nutrition, Faculty of Public Heath, Khon Kaen University, Khon Kaen, Thailand
| | - Chaisiri Wongkham
- Department of Biochemistry, Khon Kaen University, Khon Kaen, Thailand.,Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sopit Wongkham
- Department of Biochemistry, Khon Kaen University, Khon Kaen, Thailand.,Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Seiji Okada
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811, Japan.
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Wu BS, Hu Y, Sun J, Wang JL, Wang P, Dong WW, Tao HT, Gao WJ. Analysis on the characteristics and prognosis of pulmonary neuroendocrine tumors. Asian Pac J Cancer Prev 2014; 15:2205-10. [PMID: 24716958 DOI: 10.7314/apjcp.2014.15.5.2205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To retrospectively review the clinical characteristics and analyze the prognostic factors of Chinese patients with pulmonary neuroendocrine tumors. MATERIALS AND METHODS The clinical data of 176 patients with pulmonary neuroendocrine tumors in Chinese PLA General Hospital from Mar., 2000 to Oct., 2012 were retrospectively analyzed. The parameters were evaluated by univariate and multivariate analysis, including the gender, age, smoking history, family history, TNM staging, localization (central or peripheral), tumor size, nodal status, histological subtype and treatment (operation or non-operation). RESULTS There were 23 patients with typical carcinoids (TC) (13.1%), 41 with atypical carcinoids (AC) (23.3%), 10 with large cell neuroendocrine carcinoma (LCNEC) (5.7%) and 102 with small cell lung cancer (SCLC) (57.9%). The median follow-up time was 64.5 months for AC, 38 months for LCNEC and 27 months for SCLC. The typical carcinoid censored data was 18 (more than 50% of the patients), so the median follow-up time was not obtained, and actuarial 5-year survivals for TC, AC, LCNEC and SCLC were 75.1%, 51.7%, 26.7% and 38.8%, respectively. COX univariate analysis revealed that the age (P=0.001), histological subtype (P=0.005), nodal status (P=0.000), treatment (P=0.000) and TNM staging (P=0.000) were the prognostic factors of the patients with pulmonary neuroendocrine tumors, whereas its multivariate analysis showed that only the age(P=0.001), TNM staging (P=0.002) and treatment (P=0.000) were independent prognostic factors. CONCLUSIONS Radical surgery remains the treatment of choice, and is the only curative option. The age, TNM staging and treatment are confirmed to be the independent prognostic factors in multivariable models for pulmonary neuroendocrine tumors.
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Affiliation(s)
- Bai-Shou Wu
- First Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China E-mail :
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9
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Sinn M, Nicolaou A, Ricke J, Podrabsky P, Seehofer D, Gebauer B, Pech M, Neuhaus P, Dörken B, Riess H, Hildebrandt B. Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with primary liver cancer: a phase II-study (NCT00356161). BMC Gastroenterol 2013; 13:125. [PMID: 23927554 PMCID: PMC3751555 DOI: 10.1186/1471-230x-13-125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 08/01/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatic arterial infusion (HAI) of chemotherapy requires the implantation of a transcatheter application system which is traditionally performed by surgery. This procedure, but particularly the adjacent drug application via pump or port is often hampered by specific complications and device failure. Interventionally implanted port catheter systems (IIPCS) facilitate the commencement of HAI without need for laparatomy, and are associated with favorable complication rates. We here present an evaluation of the most important technical endpoints associated with the use of IIPCS for HAI in patients with primary liver cancers. METHODS 70 patients (pts) with hepatocellular (HCC, n=33) and biliary tract cancer (BTC, n=37) were enrolled into a phase II -study. Of those, n=43 had recurrent disease and n=31 suffered from liver-predominant UICC-stage IVb. All pts were provided with IIPCSs before being treated with biweekly, intraarterial chemotherapy (oxaliplatin, 5-Flourouracil, folinic acid). The primary objective of the trial was defined as evaluation of device-related complications and port duration. RESULTS Implantation of port catheters was successful in all patients. Mean treatment duration was 5.8 months, and median duration of port patency was not reached. Disease-progression was the most common reason for treatment discontinuation (44 pts., 63%), followed by chemotherapy-related toxicity (12 pts., 17%), and irreversible device failure (5 pts., 7%). A total of 28 port complications occurred in 21 pts (30%). No unexpected complications were observed. CONCLUSIONS HAI via interventionally implanted port catheters can be safely applied to patients with primary liver tumors far advanced or/and pretreated.
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Affiliation(s)
- Marianne Sinn
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
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10
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Halfdanarson TR, Haraldsdottir S, Borad MJ. Advances in systemic therapy for advanced pancreatobiliary malignancies. F1000Res 2013; 2:105. [PMID: 24327864 PMCID: PMC3752657 DOI: 10.12688/f1000research.2-105.v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2013] [Indexed: 12/24/2022] Open
Abstract
Pancreatobiliary malignancies are relatively uncommon and the overall prognosis is poor. Treatment options for advanced disease are limited to systemic therapy for metastatic disease and a combination of systemic therapy and radiation therapy for locally advanced but unresectable tumors. There have been significant advances in the treatment of pancreatobiliary cancers in recent years but the prognosis for patient survival remains disappointingly poor. We review the current treatment options for locally advanced pancreatobiliary malignancies and highlight recent advances in systemic therapy, including novel approaches using targeted treatments.
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Affiliation(s)
| | | | - Mitesh J Borad
- Division of Hematology and Medical Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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11
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Bourmèche M, Ben Salah H, Kallel M, Beyrouti M, Makni S, Boudawara T, Frikha M, Daoud J. Une longue survie après traitement d’un carcinome épidermoïde de la vésicule biliaire. Cancer Radiother 2013; 17:58-61. [DOI: 10.1016/j.canrad.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 11/15/2022]
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12
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Hari DM, Howard JH, Leung AM, Chui CG, Sim MS, Bilchik AJ. A 21-year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate? HPB (Oxford) 2013; 15:40-8. [PMID: 23216778 PMCID: PMC3533711 DOI: 10.1111/j.1477-2574.2012.00559.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 08/06/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. METHODS The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub-stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log-rank and Cox's regression analyses. RESULTS Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow-up of 22 months, 288 (25.8%) had died of GBC. Five-year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease-specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013). CONCLUSIONS In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered.
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Affiliation(s)
- Danielle M Hari
- Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health CenterSanta Monica, CA, USA
| | - J Harrison Howard
- Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health CenterSanta Monica, CA, USA
| | - Anna M Leung
- Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health CenterSanta Monica, CA, USA
| | - Connie G Chui
- Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health CenterSanta Monica, CA, USA
| | - Myung-Shin Sim
- Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health CenterSanta Monica, CA, USA
| | - Anton J Bilchik
- Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health CenterSanta Monica, CA, USA,California Oncology Research InstituteLos Angeles, CA, USA
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13
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Cereda S, Belli C, Reni M. Adjuvant treatment in biliary tract cancer: To treat or not to treat? World J Gastroenterol 2012; 18:2591-6. [PMID: 22690066 PMCID: PMC3369994 DOI: 10.3748/wjg.v18.i21.2591] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
Biliary tract cancer is a rare malignant tumor. There is limited knowledge about biology and natural history of this disease and considerable uncertainty remains regarding its optimal diagnostic and therapeutic management. The role of adjuvant therapy is object of debate and controversy. Although resection is identified as the most effective and the only potentially curative treatment, there is no consensus on the impact of adjuvant chemotherapy and/or radiotherapy on the high incidence of disease recurrence and on survival. This is mainly due to the rarity of this disease and the consequent difficulty in performing randomized trials. The only two prospectively controlled trials concluded that adjuvant chemotherapy did not improve survival. Most of the retrospective trials, which had limited sample size and included heterogeneous patients population and non-standardized therapies, suggested a marginal benefit of chemoradiotherapy in reducing locoregional recurrence and an uncertain impact on survival. Well-designed multi-institutional randomized trials are necessary to clarify the role of adjuvant therapy. Two ongoing phase III trials may provide relevant information.
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14
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Abstract
Gallbladder cancer (GBC) is the leading cause of cancer related mortality in certain geographic areas. Most of the patients with GBC have advanced disease at presentation, precluding curative resection resulting in a dismal prognosis. However, recent advances in the understanding of its epidemiology and pathogenesis coupled with development of newer diagnostic tools and therapeutic options, has resulted in enhanced optimism towards the management of the disease. The leading risk factors are gallstones, advancing age, female gender, anomalous pancreaticobiliary ductal junction, certain ethnic groups and geographic populations. Advances in radiological imaging and the advent of endoscopic ultrasound have facilitated early detection and accurate staging of the tumor. A high index of suspicion in high risk groups is necessary to pick up incidental and early GBC, as surgical resection is curative. In patients with suspected GBC, an open surgical resection that is appropriate for that stage is advocated. Adjuvant combination chemotherapy and molecular targeted therapy are emerging as effective therapeutic options in those with advanced GBC. Endoscopic palliation of biliary and gastric outlet obstruction with metallic stents has improved their quality of life. Prevention remains the hitherto less explored option to reduce GBC related mortality. Prophylactic cholecystectomy in high risk groups is a cost-effective option. A multi-disciplinary systematic global approach to initiate collaborative ventures to understand epidemiology, standardize management strategies, conduct multi-centric trials with newer therapeutic agents and initiate preventive measures, would pave way for the future conquest of the disease.
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Affiliation(s)
- Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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15
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Feliu J, Sastre J, Maurel J, Isla D. Hepatocellular and biliary tract carcinomas: SEOM clinical guidelines. Clin Transl Oncol 2011; 13:536-44. [PMID: 21821487 DOI: 10.1007/s12094-011-0694-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
While hepatocellular carcinoma (HCC) is a relatively common tumour with an annual incidence in the EU of 8 cases/100,000 inhabitants, bile tract carcinoma (BTC) is much less common, with an incidence of 4 cases per 100,000 inhabitants per year. In both cases, when planning treatment it is essential to perform accurate staging, evaluate hepatic functional reserve and performance status, and obtain the opinion of the patient. The only curative treatment is surgery. However, several interventional radiological techniques can help to achieve local disease control and the alleviation of symptoms. In addition, sorafenib (HCC) and chemotherapy (BTC) may contribute to prolong survival in patients with disseminated disease. Therefore, the therapeutic strategy should always be discussed and planned within a multidisciplinary tumour board.
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Affiliation(s)
- Jaime Feliu
- Medical Oncology Department, Hospital Universitario La Paz (IdiPAZ), RETICC, Madrid, Spain.
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Ishak G, Ribeiro FS, Costa DSD, Bahia LAC, Dias EM, Assumpção PPD. Câncer de vesícula biliar: experiência de 10 anos em um hospital de referência da Amazônia. Rev Col Bras Cir 2011; 38:100-4. [DOI: 10.1590/s0100-69912011000200006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 03/23/2010] [Indexed: 12/29/2022] Open
Abstract
OBJETIVO: Analisar os aspectos epidemiológicos-cirúrgicos dos pacientes com câncer de vesícula biliar (CAVB) atendidos em um Hospital Universitário de Belém/PA, no período de 1999-2009. MÉTODOS: estudo observacional, retrospectivo, descritivo-analítico de fonte secundária dos pacientes com diagnóstico de CAVB, no período de 1999-2009. Foram analisados 75 prontuários, sendo 34 pacientes estudados. As informações coletadas foram utilizadas para o estadiamento tumoral TNM do CAVB e para a caracterização clínico-cirúrgica da população estudada. RESULTADOS: 79% eram do sexo feminino, com média de idade de 66,2±11 anos e tempo de sintomatologia de 10,8±17,2 meses, não obtendo relação estatística com o estadio da doença. Dor no hipocôndrio direito, náuseas e icterícia predominaram como sinais/sintomas. A litíase biliar esteve presente em 91% dos casos, sendo positiva em 100% dos pacientes com estadios I/II. A sensibilidade ultrassonográfica para sugestionar o CAVB no pré-operatório foi 14,28%. A operação mais executada foi a colecistectomia simples, tendo como achado intra-operatório predominante, invasão hepática. O adenocarcinoma foi o tipo histológico preponderante, com destaque para os estadios III e IV. CONCLUSÃO: A série estudada apresentou alta incidência de litíase biliar, o adenocarcinoma com estadio avançado foi o mais prevalente. acarretando um pequeno índice de operações com intenção curativa, 30% dos pacientes operados, e uma taxa de mortalidade de 21%. A valorização dos sintomas e a investigação precoce por exames de imagem poderiam favorecer o tratamento, em fases iniciais do CAVB, proporcionando um melhor prognóstico para os pacientes operados.
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Lee SE, Jang JY, Lim CS, Kang MJ, Kim SW. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol 2011; 17:174-80. [PMID: 21245989 PMCID: PMC3020370 DOI: 10.3748/wjg.v17.i2.174] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 09/09/2010] [Accepted: 09/16/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of simple and extended cholecystectomy for mucosa (T1a) or muscularis (T1b) gallbladder (GB) cancer.
METHODS: Original studies on simple and extended cholecystectomy for T1a or T1b GB cancer were searched from MEDLINE (PubMed), Cochrane Library, EMBase, and CancerLit using the search terms of GB, cancer/carcinoma/tumor/neoplasm.
RESULTS: Twenty-nine out of the 2312 potentially relevant publications met the eligibility criteria. Of the 1266 patients with GB cancer included in the publications, 706 (55.8%) and 560 (44.2%) had T1a and T1b GB cancer, respectively. Simple cholecystectomy for T1a and T1b GB cancer was performed in 590 (83.6%) and 375 (67.0%) patients, respectively (P < 0.01). In most series, the treatment of choice was simple cholecystectomy for T1a GB cancer patients with a 5-year survival rate of 100%. Lymph node metastasis was detected in 10.9% of the T1b GB cancer patients and in 1.8% of the T1a GB cancer patients, respectively (P < 0.01). Eight patients (1.1%) with T1a GB cancer and 52 patients (9.3%) with T1b GB cancer died of recurrent GB cancer (P < 0.01).
CONCLUSION: Simple cholecystectomy represents the adequate treatment of T1a GB cancer. There is no definite evidence that extended cholecystectomy is advantageous over simple cholecystectomy for T1b GB cancer.
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