Verma Saurav, Grindrod Natalie, Breadner Daniel, Lock Michael
Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada.
London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada.
Cancers (Basel). 2024 May 4;16(9):1776. doi: 10.3390/cancers16091776.
Cholangiocarcinoma (CCA) is a rare cancer of bile ducts. It is associated with a poor prognosis. The incidence of CCA is rising worldwide. Anatomical subgroups have been used to classify patients for treatment and prognosis. There is a growing understanding of clinically important distinctions based on underlying genetic differences that lead to different treatment options and outcomes. Its management is further complicated by a heterogeneous population and relative rarity, which limits the conduct of large trials to guide management. Surgery has been the primary method of therapy for localized disease; however, recurrence and death remain high with or without surgery. Therefore, there have been concerted efforts to investigate new treatment options, such as the use of neoadjuvant treatments to optimize surgical outcomes, targeted therapy, leveraging a new understanding of immunobiology and stereotactic radiation. In this narrative review, we address the evidence to improve suboptimal outcomes in unresectable CCA with radiation, as well as the role of radiation in neoadjuvant and postoperative treatment. We also briefly discuss the recent developments in systemic treatment with targeted therapies and immune checkpoint inhibitors.
胆管癌（CCA）是一种罕见的胆管癌症。其预后较差。全球范围内CCA的发病率正在上升。解剖学亚组已被用于对患者进行治疗和预后分类。基于潜在基因差异导致不同治疗选择和结果的临床重要区别正得到越来越多的认识。其治疗因人群异质性和相对罕见性而进一步复杂化，这限制了开展大型试验来指导治疗。手术一直是局限性疾病的主要治疗方法；然而，无论是否进行手术，复发率和死亡率仍然很高。因此，人们一直在共同努力研究新的治疗选择，例如使用新辅助治疗来优化手术结果、靶向治疗、利用对免疫生物学的新认识以及立体定向放射治疗。在这篇叙述性综述中，我们阐述了改善不可切除CCA放疗效果欠佳的证据，以及放疗在新辅助治疗和术后治疗中的作用。我们还简要讨论了靶向治疗和免疫检查点抑制剂在全身治疗方面的最新进展。
