Biliary Tract Carcinoma / Cholangiocarcinoma                                                                                        101

 

16.    Biliary Tract Carcinoma / Cholangiocarcinoma 

 

16.1        General considerations

Stage grouping

Stage

0                                      Tis                                          N0                                  M0

I                                       T1                                          N0                                  M0

II                                      T2                                          N0                                  M0

III                                     T1/2                                       N1/2                                M0

IV A                                  T3                                          any N                             M0

IV B                                   any T                                     any N                             M1

           

            Histologically, 95% of bile duct carcinoma are adenocarcinomas.

 

If possible, curative resection is the treatment of choice, and in patients with non-resectable lesion stenting for palliation should be aimed at , if technically possible. The role of radiotherapy and of chemotherapy remains more controversial. To date no chemotherapy regimen can be considered as standard.

 

            Literature: for review e.g.

           

            AHRENDT et al, Clin. Liver Dis. 5 (2001): 191 – 218

            HEJNA et al, Eur. J. Cancer 34 (1998):  977 – 986

            RUMALLA and PETERSEN, Semin. Gastrointest. Dis. 11 (2000): 168 – 173

            TODOROKI, Hepato- Gastroenterology 47 (2000): 644 – 649

Van RIEL et al, Ann. Oncol. 10 (Suppl 4) (1999): 157 – 161 (chemotherapeutic possibilities in bile duct carcinoma)

 

16.2        Single agent chemotherapy

5-Fluorouracil and mitomycin, are among the most studied drugs with some efficacy. From the newer drugs docetaxel and gemcitabine were reported to be active in smaller phase II studies; e.g.

5 – Fluorouracil                    500 mg/m2           i.v.                                d 1 – 5 * or

                                              600 mg/m2           i.v.                                d 1, 8, 15,…………..

* To be repeated every 4 weeks

 

Gemcitabine                           1000mg/m2          i.v.(30 min inf)           d 1, 8, 15

Followed by a 15- day rest period

 

Literature:

            GEBBIA et al, J. Clin. Oncol. 19 (2001): 4089 – 4091

 

Gemcitabine                             2200 mg/m2         i.v. (30 min inf)         d 1

To be repeated every 2 weeks (for 6 months)

 

Literature:        

            PENZ et a. Ann. Oncol. 12 (2001): 183 – 186

 

102                                                                                           Biliary Tract Carcinoma / Cholangiocarcinoma                                     

 

           

Docetaxel                                  100 mg /m2              i.v. (1 h inf)               d 1

            To be repeated every 3 weeks

 

            Literature:

                        PAPAKOSTAS et al, Eur. J. Cancer 37 (2001): 1833 – 1838

 

16.3        Combination chemotherapy

 

16.3.1 FLM

5 – Fluorouracil                         400 mg/m2                   i.v.                               d 1 –  4

Leucovorin                                200 mg/m2                    i.v.                               d 1 – 4

Mitomycin                                 8 mg /m2                       i.v.                               d 1

To be repeated every 4 weeks

 

Literature:

            RADERER et al, Oncology 56 (1999): 177 – 180

 

16.3.2 5 – Fluorouracil + interferon alpha

5 – Fluorouracil                           750 mg /m2                i.v.(cont inf)                       d 1 – 5

Interferon alpha                           5 x 106 IU                  s.c.                                      d 1, 3, 5

            To be repeated every 2 weeks (outpatient treatment )

 

            Literature:

                        PATT et al, J. Clin. Oncol. 14 (1996): 2311 – 2315