Hejna M, Pruckmayer M, Raderer M
Department of Internal Medicine I, University of Vienna, Austria.
Eur J Cancer. 1998 Jun;34(7):977-86. doi: 10.1016/s0959-8049(97)10166-6.
Carcinoma of the biliary tract is a rare tumour. To date, there is no therapeutic measure with curative potential apart from surgical intervention. Thus, patients with advanced, i.e. unresectable or metastatic disease, face a dismal prognosis. They present a difficult problem to clinicians as to whether to choose a strictly supportive approach or to expose patients to the side-effects of a potentially ineffective treatment. The objective of this article is to review briefly the clinical trials available in the current literature utilising non-surgical oncological treatment (radiotherapy and chemotherapy) either in patients with advanced, i.e. locally inoperable or metastatic cancer of the biliary tract or as an adjunct to surgery. From 65 studies identified, there seems to be no standard therapy for advanced biliary cancer. Despite anecdotal reports of symptomatic palliation and survival advantages, most studies involved only a small number of patients and were performed in a phase II approach. In addition, the benefit of adjuvant treatment remains largely unproven. No clear trend in favour of radiation therapy could be seen when the studies included a control group. In addition, the only randomised chemotherapeutic series seemed to suggest a benefit of treatment in advanced disease, but due to the small number of patients included, definitive evidence from large, randomised series concerning the benefit of non-surgical oncological intervention as compared with supportive care is still lacking. Patients with advanced biliary tract cancer should be offered the opportunity to participate in clinical trials.
胆管癌是一种罕见的肿瘤。迄今为止，除了手术干预外，尚无具有治愈潜力的治疗措施。因此，患有晚期疾病（即不可切除或转移性疾病）的患者预后不佳。对于临床医生来说，这是一个难题，即究竟是选择严格的支持性治疗方法，还是让患者承受可能无效的治疗所带来的副作用。本文的目的是简要回顾当前文献中有关在晚期胆管癌患者（即局部无法手术或转移性胆管癌患者）中使用非手术肿瘤治疗（放疗和化疗）或作为手术辅助治疗的临床试验。从检索到的65项研究来看，晚期胆管癌似乎没有标准治疗方法。尽管有关于症状缓解和生存优势的传闻报道，但大多数研究仅涉及少数患者，且采用的是II期研究方法。此外，辅助治疗的益处仍 largely未经证实。当研究纳入对照组时，未发现明显有利于放疗的趋势。此外，唯一的随机化疗系列似乎表明治疗对晚期疾病有益，但由于纳入患者数量较少，仍缺乏来自大型随机系列研究的确切证据，以证明与支持性治疗相比，非手术肿瘤干预的益处。晚期胆管癌患者应获得参与临床试验的机会。
