Current treatment outcome of hilar cholangiocarcinoma

Dong, Seok Ho

Abstract

Cholangiocarcinoma (CC) is one of the most lethal cancers defying long-term control of disease. Hilar cholangiocarcinoma (Klatskin tumor) which occur at the confluence of right and left hepatic ducts are getting special attention for these tumors due to difficult management. Surgical treatment of hilar cholangiocarcinoma remains difficult and most of patients are diagnosed when unresectable. The 5-year survival rate after curative resection was 20~40% with median survival of 12~16 months. In those patients with unresectable hilar CC, liver failure and recurrent sepsis secondary to biliary obstruction occupy substantial proportion of cause of death. For most of these patients endoscopic or percutaneous biliary drainage provides effective palliation. Palliative chemotherapy and radiation therapy either alone or in combination have been relatively ineffective for unresectable cholangiocarcinoma. A photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. In addition to these options, newly developed target therapies are promising, but still experimental treatment. Liver transplantation in combination with neoadjuvant chemoradiation therapy seems to be an option for a highly selected group of patients. The development of new therapeutic options and multimodal promising combinations of the palliative therapeutic options is expected to improve the health-related quality of life and prolong the overall survival.