Adjuvant chemotherapy after Whipple's for chalngiocarcinoma.
Posted Nov 05 2010 12:05pm
The role of adjuvant chemothhapy after complete resection of cholangiocarcinoma is changing. The cancer have a high incidence of local failure after surgical resection reaching 52%, a locoregional adjuvant treatment may be considered. Several retrospective reports on adjuvant and recently also on neoadjuvant (chemo)radiotherapy suggest survival benefit in both gallbladder and biliary duct cancer and postoperative chemoirradiation may be considered as an option. Fluorouracil was mostly used for chemoradiotherapy in biliary cancers. Recently concomitant gemcitabine with or without oxaliplatin has shown feasibility with radiotherapy in this disease." In contrast, a 2008 guideline does not support adjuvant chemo outside of clincal trials.
For extrahepatinc cholangiocarcinoma, NCCN recommend chemoradiation with floropyrimidines and then adjvant chemo with the same or gemcitabine based. It does the same or a clincal trial for clean margins, excluding the chemoradiation. It does not mention oxaliplatin.
F. Eckel, T. Brunner S. Jelicand On behalf of the ESMO Guidelines Working Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol (2010) 21 (suppl 5): v65-v69.
Junji Furuse, Tadahiro Takada, Masaru Miyazaki, Shuichi Miyakawa, Kazuhiro Tsukada, Masato Nagino, Satoshi Kondo, Hiroya Saito, Toshio Tsuyuguchi and Koichi Hirata, et al. Guidelines for chemotherapy of biliary tract and ampullary carcinomas, Jrnal of Hepato-Biliary-Pancreatic Surgery Volume 15, Number 1, 55-62