Unresectable hilar cholangiocarcinoma treated with chemoradiotherapy: a 9-year survival case
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CASE REPORT
Unresectable hilar cholangiocarcinoma treated with chemoradiotherapy: a 9‑year survival case Takeshi Sakata1 · Takahiro Yoshikawa1 · Takeo Nomi1 · Yasuko Matsuo1 · Naoki Kamitani1 · Daisuke Hokuto1 · Masayuki Sho1 Received: 20 May 2020 / Accepted: 3 September 2020 © The Japan Society of Clinical Oncology 2020
Abstract Patients with advanced unresectable hilar cholangiocarcinoma have poor prognosis, and the survival is usually short. Herein, we report a 9-year survival case of unresectable hilar cholangiocarcinoma treated with chemoradiotherapy. A 64-year-old male patient presented with hilar cholangiocarcinoma. The tumor was located in the right hepatic duct, and it extended from the bifurcation of the anterior and posterior branches to the periphery. In the left side, the tumor extended from the umbilical portion to B2 and B3. However, there was no distant metastasis. The patient was then diagnosed with locally advanced, unresectable hilar cholangiocarcinoma and was treated with chemoradiotherapy. He received a total dose of 60 Gy in 30 daily fractions via intensity-modulated radiation therapy. In addition, he received gemcitabine chemotherapy for 5 years. There has been neither re-elevation of carbohydrate antigen 19-9 levels nor tumor relapse for 5 years during chemotherapy. Therefore, gemcitabine treatment was discontinued. However, the patient experienced tumor relapse 3 years after the last chemotherapy. Hence, chemotherapy with gemcitabine and cisplatin was initiated. At present, 1 year has passed after treatment for recurrence, and the patient has survived for 9 years since the initial treatment. Herein, we report a rare case of long-term survival with chemoradiotherapy in locally advanced unresectable hilar cholangiocarcinoma. Keywords Hilar cholangiocarcinoma · Chemoradiotherapy · Long-term survival
Introduction Hilar cholangiocarcinoma, also known as Klatskin tumors, accounts for 60–70% of all cholangiocarcinoma cases, and major surgical challenges are faced when managing this type of tumor as it is commonly located adjacent to the pivotal structures. However, in world-famous, high-volume centers, the 5-year survival rate of patients after surgery is 30–40%. Hence, the long-term outcomes of surgery for hilar cholangiocarcinoma have not reached satisfactory levels [1–5]. By contrast, the unresectability rates remain high at 24–66%, and it can be attributed to the tumor involving the bilateral second-order biliary radicals, main or bilateral portal vein or hepatic artery invasion, presence of hepatic lobar atrophy with contralateral second-order biliary radical or major vascular involvement, and distant metastases [4, 6, 7]. * Takahiro Yoshikawa t.yoshokawa@naramed‑u.ac.jp 1
Department of Surgery, Nara Medical University, 840 Shijo‑cho Kashihara‑shi, Nara 634‑8522, Japan
In terms of palliative therapies for unresectable hilar cholangiocarcinoma, chemoradiotherapy can achieve satisfactory local tumor control, and it may have survival benefits. Herein, we report a case of long-term survi
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