Locoregional therapies in cholangiocarcinoma

Abstract

Cholangiocarcinoma is a rare and aggressive malignancy of the biliary tract. Complete surgical resection can be curative, but the majority of patients are diagnosed with advanced disease and usually die within a year of diagnosis. Most deaths are attributable to local disease progression rather than distant metastases, supporting the use of locoregional therapies. There is evidence that locoregional therapies can provide local tumor control resulting in increased survival while avoiding some of the side effects of systemic treatments, increasing potential treatment options for patients who may be unsuitable for systemic palliative treatments. This review considers the evidence for locoregional therapies in cholangiocarcinoma, which can be classified into endoscopic, vascular, percutaneous and radiation oncological therapies. Current guidelines do not recommend the routine use of locoregional therapies due to a lack of prospective data, but the results of ongoing trials are likely to increase the evidence base and impact on clinical practice.

Keywords: ablation techniques; brachytherapy; cholangiocarcinoma; cholangiopancreatography; embolization; endoscopic retrograde; endosonography; photochemotherapy; proton therapy; radiotherapy; stents; therapeutic.

Conflict of interest statement

Financial & competing interests disclosure

R Sharma declares honoraria/consultancy not related to the submitted work with Sirtex, BTG, Terumo, Boston Scientific and Varian. P Labib's PhD is part funded by the Limoges Charitable Trust (charity no: 1016178). R Sharma and S Pereira are supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. R Sharma declares research funding from Cancer Research UK, Sirtex Medical and BTG plc and S Pereira is supported by NIH grant P01 CA084203. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.. Locoregional therapies in cholangiocarcinoma.