肝门部胆管癌的放射治疗、化学疗法和放化疗。
Radiation therapy, chemotherapy and chemoradiation in hilar cholangiocarcinoma.
机构信息
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
出版信息
HPB (Oxford). 2005;7(4):278-82. doi: 10.1080/13651820500373028.
BACKGROUND
Hilar cholangiocarcinoma is a rare tumour which is best managed by an aggressive surgical approach. The role of adjuvant or neoadjuvant radiation therapy, chemotherapy or chemoradiation remains controversial, as no prospective randomized studies have been performed.
METHODS
This review summarizes the recent literature regarding the role of radiation, chemotherapy and chemoradiation in hilar cholangiocarcinoma. The results of a biliary cancer questionnaire regarding current treatment strategies are also reported.
RESULTS
A number of retrospective studies have shown that patients treated with adjuvant radiation therapy have prolonged survival compared with untreated patients. However, most of these reports did not control for tumour stage or performance status. A carefully controlled trial from the Johns Hopkins Hospital did not demonstrate any benefit for adjuvant radiation therapy. A number of phase II trials of chemotherapy have demonstrated modest response rates (20-40%). The best responses have been reported with 5-fluorouracil (5-FU) in combination with interferon-alpha or with leucovorin and mitomycin C. Recent non-randomized reports of chemoradiation with 5-FU with or without gemcitabine as the radiosensitizer suggest, but do not prove, improved survival. Adjuvant chemoradiation is currently being employed at specialized centres most often in the Americas (71%) and the Asia/Pacific region (55%) and to a lesser degree in Europe (29%).
DISCUSSION
The only chance for long-term survival in patients with hilar cholangiocarcinoma is complete resection with negative margins. Neither radiation therapy nor chemotherapy alone has been proven to prolong survival in completely or partially resected patients or in unresected patients. Recent uncontrolled data suggest that chemoradiation may improve survival in resected and locally unresectable patients. However, prospective, randomized multicentre trials need to be performed to confirm efficacy.
背景
肝门部胆管癌是一种罕见的肿瘤，最好通过积极的手术方法进行治疗。辅助或新辅助放疗、化疗或放化疗的作用仍存在争议，因为尚未进行前瞻性随机研究。
方法
本文综述了关于放疗、化疗和放化疗在肝门部胆管癌中的作用的最新文献。还报告了胆道癌问卷关于当前治疗策略的结果。
结果
一些回顾性研究表明，接受辅助放疗的患者与未治疗的患者相比，生存时间延长。然而，这些报告大多数都没有控制肿瘤分期或功能状态。约翰霍普金斯医院的一项精心控制的试验并未显示辅助放疗有任何益处。一些化疗的二期临床试验显示出适度的反应率（20-40%）。最好的反应是氟尿嘧啶（5-FU）联合干扰素-α或亚叶酸和丝裂霉素 C 报道。最近关于氟尿嘧啶加或不加吉西他滨作为增敏剂的放化疗的非随机报告表明，但不能证明生存得到改善。辅助放化疗目前主要在美洲（71%）和亚太地区（55%）的专门中心以及欧洲（29%）的程度较低地应用。
讨论
肝门部胆管癌患者长期生存的唯一机会是完全切除且切缘阴性。单独放疗或化疗均不能延长完全或部分切除的患者或未切除的患者的生存时间。最近的非对照数据表明，放化疗可能改善切除和局部不可切除患者的生存。然而，需要进行前瞻性、随机、多中心试验来证实其疗效。
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