P-0174 Biliary Tract Cancer in a Moroccan Medical Oncology Unit

Abstract

ABSTRACT Introduction Biliary tract cancers (BTC) are relatively rare (3% of digestive cancers), they mainly affect older women and are located in the gallbladder in about 70% of the cases. Methods In this retrospective study, we reviewed 70 cases of BTC admitted in the medical oncology unit of HASSAN II university hospital between January 2008 and January 2012. The aim of this study is to define epidemiologic, diagnostic and therapeutic aspects of this disease in a Moroccan population. Results In our study, BTC account for 4.8 % of digestive cancers. The mean age of our patients was 62.4 years ranged from 32 to 81 years, female gender represent 71 %. The tumors were located in the gallbladder (GB) in 72 % of the cases divided into adenocarcinoma (77 %) and squamous cell carcinoma (23 %). The other locations were hilar cholangiocarcinoma (21 %) and intrahepatic cholangiocarcinoma (7 %). Concerning the radiological finding, abdominal ultrasonography was performed in all of the patients but it allowed to suspect cancer in only 47% of the cases. Magnetic resonance cholangiographic was performed (n=16) and allowed to suspect cancer in all of these patients. Incidental finding of gallbladder cancer at surgery was recorded in 24 patients: intraoperatively in 10 cases or after pathological study in 14 cases. For all the cases of BTC, Staging of the disease was based on the thoraco-abdomino-pelvic scan and divided into localized stage (7 %), locally advanced stage (14 %) and metastatic stage (79 %). The site of metastases was as following: liver (85 %), lymph nodes (43 %), lung (35 %), peritoneum (25 %), bone (7.5 %), and soft subcutaneous metastasis (5 %). An initial complete surgery in gallbladder cancer (extended cholecystectomy including en bloc hepatic resection and lymphadenectomy with or without bile duct excision) was performed in 7 patients. A second curative surgery was performed in 8 patients. A complete surgery in cholangiocarcinoma cases (n=20) was performed in 6 patients. A palliative surgery was done in 24 patients of all BTC: cholecystectomy (n=9) and biliary drainage (n=15). In all the BTC metastatic patients (n=55), a palliative chemotherapy was administered as following: combination of cisplatin and gemcitabine (n=22), gemcitabine alone (n=10), combination of oxaliplatin and gemcitabine (GEMOX) (n=5), combination of cisplatin and 5 fluorouracil (n=4), capecitabine alone (n=4), combination of capecitabine and oxaliplatin (XELOX) (n=2), and FUFOL Mayo clinic (n=2). While 9% of the patients received supportive care because of their comorbidities and the deterioration of the performans status and liver blood tests. Conclusion Because of the silent evolution of BTC, the diagnosis is therefore delayed, the prognosis is poor and treatment is usually palliative. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects. A multidisciplinary approach including methods for early diagnosis, oncologic surgery and chemotherapy is recommended to improve the prognosis of patients with biliary tract cancers.