Treatment of cholangiocarcinoma complicating primary sclerosing cholangitis

The mayo clinic experience

Mushin Kaya, Piet C. De Groen, Paul Angulo, David M. Nagorney, Leonard L. Gunderson, Gregory J. Gores, Michael G. Haddock, Keith Lindor

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: The aims of this retrospective study were to assess the frequency with which we used different treatment modalities for patients with primary sclerosing cholangitis (PSC) and cholangiocellular carcinoma (CCA). METHODS: A total of 41 patients with known CCA complicating PSC with a median age of 49 yr (range, 27-75 yr) were identified from a group of 1009 patients (4%) with PSC seen over 10 yr at the Mayo Clinic. RESULTS: These patients received mainly five forms of treatment: 10 patients were treated with radiation therapy (RT) with or without 5-fluorouracil (5-FU) (seven with palliative and three with curative intent), nine with stent placement for cholestasis, 12 with conservative treatment, four with surgical resection (one of four received RT and 5-FU), and three patients with orthotopic liver transplantation and RT, with or without 5-FU. One patient was treated with 5-FU alone, one with photodynamic therapy, and one patient with somatostatin analog. A total of 36 patients died, whereas four (10%) patients survived (two with surgical resection, one with orthotopic liver transplantation and RT, and one with stent placement) during a median follow-up of 5.5 months (range, 1-75 months). One patient was lost to follow-up. CONCLUSIONS: In highly selective cases, resective surgery seems to be of benefit in PSC patients with CCA. However, these therapies are rarely applied to these patients because of the advanced nature of the disease at the time of diagnosis. Efforts should be directed at earlier identification of potential surgical candidates.

Original languageEnglish (US)
Pages (from-to)1164-1169
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume96
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

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Sclerosing Cholangitis
Cholangiocarcinoma
Fluorouracil
Therapeutics
Radiotherapy
Liver Transplantation
Stents
Lost to Follow-Up
Cholestasis
Photochemotherapy
Somatostatin

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Treatment of cholangiocarcinoma complicating primary sclerosing cholangitis : The mayo clinic experience. / Kaya, Mushin; De Groen, Piet C.; Angulo, Paul; Nagorney, David M.; Gunderson, Leonard L.; Gores, Gregory J.; Haddock, Michael G.; Lindor, Keith.

In: American Journal of Gastroenterology, Vol. 96, No. 4, 2001, p. 1164-1169.

Research output: Contribution to journalArticle

Kaya, Mushin ; De Groen, Piet C. ; Angulo, Paul ; Nagorney, David M. ; Gunderson, Leonard L. ; Gores, Gregory J. ; Haddock, Michael G. ; Lindor, Keith. / Treatment of cholangiocarcinoma complicating primary sclerosing cholangitis : The mayo clinic experience. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 4. pp. 1164-1169.
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abstract = "OBJECTIVES: The aims of this retrospective study were to assess the frequency with which we used different treatment modalities for patients with primary sclerosing cholangitis (PSC) and cholangiocellular carcinoma (CCA). METHODS: A total of 41 patients with known CCA complicating PSC with a median age of 49 yr (range, 27-75 yr) were identified from a group of 1009 patients (4{\%}) with PSC seen over 10 yr at the Mayo Clinic. RESULTS: These patients received mainly five forms of treatment: 10 patients were treated with radiation therapy (RT) with or without 5-fluorouracil (5-FU) (seven with palliative and three with curative intent), nine with stent placement for cholestasis, 12 with conservative treatment, four with surgical resection (one of four received RT and 5-FU), and three patients with orthotopic liver transplantation and RT, with or without 5-FU. One patient was treated with 5-FU alone, one with photodynamic therapy, and one patient with somatostatin analog. A total of 36 patients died, whereas four (10{\%}) patients survived (two with surgical resection, one with orthotopic liver transplantation and RT, and one with stent placement) during a median follow-up of 5.5 months (range, 1-75 months). One patient was lost to follow-up. CONCLUSIONS: In highly selective cases, resective surgery seems to be of benefit in PSC patients with CCA. However, these therapies are rarely applied to these patients because of the advanced nature of the disease at the time of diagnosis. Efforts should be directed at earlier identification of potential surgical candidates.",
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