Recurrent Bile Duct Cancer Research Articles

Radiation therapy for recurrent extrahepatic bile duct cancer.

PurposeMore than half of patients with bile duct cancer (BDC) develop recurrence even after curative resection. Recurrent BDC has a poor prognosis, and no optimal treatment modality has been established. We therefore analyzed our experience on the survival outcomes of radiation therapy (RT) for recurrent extrahepatic bile duct cancer (EHBDC).Patients and methodsWe retrospectively analyzed the records of patients with recurrent EHBDC who underwent concurrent chemoradiation therapy (CCRT) or RT alone at our institution between January 2001 and June 2015. Freedom from locoregional progression (FFLP), progression-free survival (PFS), and overall survival (OS) were assessed, and univariate and multivariate analyses were performed to identify the prognostic factors.ResultsA total of 76 patients were included in the analysis. The median OS was 16 months and the rates of 2-year FFLP, PFS, and OS were 61%, 25%, and 33%, respectively. Among the evaluable patients, the first site of failure was the locoregional area in 16 patients, distant metastasis in 27, and both sites in 8. On univariate analysis, disease-free interval (p = 0.012) and concurrent chemotherapy (p = 0.040) were found as significant prognostic factors for OS. One patient with CCRT developed a grade 3 hematologic toxicity, and two patients experienced late grade 3 toxicities including duodenal ulcer bleeding and obstruction.ConclusionsRT for recurrent EHBDC showed favorable survival and local control with limited treatment-related toxicities. Considering that the most common pattern of failure was distant metastasis, further studies on the optimal scheme of chemotherapy and RT are warranted.

Criteria for liver resection for metastasis from bile duct cancer.

The surgical indications for liver metastasis from bile duct cancer remain contentious, because surgery is generally thought unlikely to improve survival. However, recent reports show that long-term survival has been achieved with liver resection of metastasis from recurrent bile duct cancer in selected patients. Liver resection for liver metastasis from bile duct cancer was proposed only when the following criteria were met: liver-only metastasis, a solitary tumor, and no increase in the number of lesions during 3months of observation. This study aimed to validate our criteria and to analyze which factors impact on survival. Between 2003 and 2017, 164 patients underwent pathologically curative resection for bile duct cancer. Recurrence developed in 98 of these patients, as liver-only metastasis in 25. Eleven of these 25 patients underwent liver resection (liver resection group), and 14 did not (non-liver resection group). The median overall survival was longer in the liver resection group than in all the patients (44months vs. 17.8months, respectively p = 0.040). The median overall survival was better in the liver resection group than in the non-liver resection group (44months vs. 19.9months, p = 0.012). The disease-free interval was also significantly longer in the liver resection group than in the non-liver resection group [22months (range; 4-34months) vs. 3months (2-11), p < 0.001]. Potentially, metachronous solitary liver metastasis from bile duct cancer is an indication for liver resection when the patient has had a long disease-free interval. Observation for 3months from first detection of metastasis may optimize the selection for this surgery.

P-214 Salvage Chemoradiotherapy for Locally Recurrent Bile Duct Cancer

P-214 Salvage Chemoradiotherapy for Locally Recurrent Bile Duct Cancer

Actionable targets in recurrent bile duct and pancreatic cancer in a prospective cohort of patients evaluated by whole exome sequencing and SNP array analysis.

e23256Background: No standard therapy exists for recurrent bile duct cancer. In this study, we characterized actionable targets in patients with recurrent bile duct- and pancreatic cancer included ...

A study of patients who underwent a repeated surgery for recurrent bile duct cancer

A study of patients who underwent a repeated surgery for recurrent bile duct cancer

Right trisectionectomy and S1 segmentectomy combined with vascular and biliary reconstruction for recurrent bile duct cancer after pancreatoduodenectomy

Right trisectionectomy and S1 segmentectomy combined with vascular and biliary reconstruction for recurrent bile duct cancer after pancreatoduodenectomy

Aggravation of Fatigue by Steroid Therapy in Terminally Ill Patients With Cancer

Steroids are commonly used for fatigue relief in terminally ill cancer patients. However, steroid-induced adverse effects including depression, myopathy, and hyperglycemia may contribute to fatigue. We report our experiences with aggravation of fatigue with steroid use in three cases. Case 1 was a 65-year-old man with advanced gastric cancer. He was started on betamethasone (2 mg/d) for fatigue, but the fatigue worsened due to steroid-induced depression. Discontinuation of steroids and initiation of an antidepressant ameliorated the fatigue. Case 2 was a 68-year-old man with advanced lung cancer. He complained of fatigue. Betamethasone (1 mg/d) was started and alleviated the fatigue. However, when the betamethasone dose was increased to 2 mg/d, the fatigue, with muscle weakness and myalgia, worsened due to steroid-induced myopathy. We therefore switched from betamethasone (2 mg/d) to prednisolone (10 mg /d). The fatigue resolved and the patient returned to his previous condition. Case 3 was a 73-year-old man with recurrent bile duct cancer. He also had diabetes mellitus. He developed fatigue, anorexia and fever. We started betamethasone (1.5 mg/d) for these symptoms, but the fatigue and anorexia worsened due to steroid-induced hyperglycemia. Blood glucose rose to 532 mg/dL. Therefore, insulin therapy was started, and the dose of betamethasone was reduced to 0.5 mg/d. His glucose level decreased to less than 320 mg/dL and he recovered from the fatigue while achieving moderate oral intake. In conclusion, the possibility of steroid-induced secondary fatigue in terminally ill cancer patients should be taken into consideration.

Preliminary experience with CT‐guided high‐dose rate brachytherapy as an alternative treatment for hepatic recurrence of cholangiocarcinoma

Background:Intrahepatic recurrence after resection of intrahepatic or hilar cholangiocarcinoma represents a main reason for the poor prognosis of bile duct cancer. As no standard treatment has been established so far, the aim of this study was to analyse the safety and efficacy of computed tomography‐guided high‐dose rate brachytherapy (CT‐HDRBT) as an alternative treatment in those patients. Methods:The outcomes of 10 patients, who had been treated at least once for recurrent cholangiocarcinoma by CT‐HDRBT, were retrospectively analysed. Results:The median survival of all patients after primary liver resection was 85 months [95% confidence interval (CI) 68.129‐101.871] with overall 1‐ and 5‐year survival rates of 100% and 78.7%, respectively. After the occurrence of intrahepatic tumour recurrence, a total of 15 CT‐HDRBT procedures were performed, alone or combined with other recurrence treatments, without any major complications according to the Society of Interventional Radiology classification. The 1‐year and 5‐year survival rates after recurrence treatment were 77.1% and 51.4%, respectively. Conclusions:CT‐HDRBT represents a safe treatment option for patients with recurrent bile duct cancer. As a part of a multimodal concept, CT‐HDRBT might lead to a prolongation of survival in selected patients but further studies are urgently needed to prove this concept.

A Case of Recurrent Bile Duct Cancer Initially Treated with Pancreaticoduodenectomy

A Case of Recurrent Bile Duct Cancer Initially Treated with Pancreaticoduodenectomy

Abdominal wall recurrence of Hilar bile duct cancer 12 years after a curative resection: Report of a case

A 74-year-old woman was diagnosed with hilar bile duct cancer, and underwent a curative resection of the bile duct and the left and caudate lobes of the liver in 1995. Ten years later (April 2005), she noted a small mass in the abdominal wall. The mass slowly enlarged to reach 4 cm in diameter by January 2007. With a diagnosis of a possible recurrence of bile duct cancer, a laparotomy was thus performed. The abdominal wall tumor was buried in the rectus abdominis muscle and was tightly attached to the ileum. The lesion was resected en bloc with the associated rectus muscle and ileocecal region. A histopathological examination of the resected specimen revealed tubular adenocarcinoma that closely resembled the original primary bile duct cancer. In addition, the immunohistochemical staining pattern of the abdominal tumor was identical to that of the original bile duct cancer. This indicated that the abdominal tumor represented a local recurrence (probably due to peritoneal implantation) at 12 years after the resection of the hilar bile duct cancer. This case emphasizes that long-time surveillance is required for patients with bile duct cancer, even if they have survived without recurrence for more than 5 years after a curative resection.

Local recurrence at hepaticojejunostomy 9 years after resection of bile duct cancer with superficial flat spread

We report a male patient aged 45 years, who in 1993 had been diagnosed as having middle bile duct cancer and had received a pancreatoduodenectomy. Histopathology showed a nodular tumor with the main lesion in the middle bile duct and superficial spreading in both proximal and distal directions (which was not observed macroscopically), and residual tumor in the epithelium of the cut edge near the liver. The patient underwent follow-up without postoperative adjuvant therapy. In 2002, 9 years after the operation, the patient developed jaundice and was diagnosed with recurrence of bile duct cancer in the anastomotic site, based on cholangiographic results. He underwent resection of the right hepatic and caudate lobes and the anastomotic region of the bile duct and jejunum. Pathological findings showed an invasive tumor in the anastomotic region, with continuous intraepithelial spread in the direction of the bile duct, which suggested that the residual tumor in the epithelium had grown to become an invasive cancer. In this patient, the recurrence required 9 years after resection. This case provides evidence for the clinical course that might be anticipated for a patient with a residual tumor in the epithelium of the bile duct stump and subsequent superficial spreading bile duct cancer.

Extended Right Hemihepatectomy as a Salvage Operation for Recurrent Bile Duct Cancer 3 Years after Pancreatoduodenectomy

Salvage surgery for recurrent bile duct cancer is generally impractical due to local invasion of surrounding major vascular structures or distant metastases. We describe a case of a relapsed tumor in the right hepatic duct 3 years after pancreatoduodenectomy for middle to distal bile duct cancer. The recurrent tumor, measuring 25 x 12 x 12 mm, was mostly confined within the right hepatic duct. It displayed an intraductal superficial extension rather than transmural invasive growth to the hepatic hilum. An extended right hemihepatectomy was successfully performed with a histologically negative margin. The patient is currently doing well without any signs of local recurrence or distant metastasis 8 months after the second operation. Precise pathological examination revealed that the lesion had originated from multicentric foci in the right hepatic duct, not as a result of anastomotic recurrence. These results raised the consideration of a potentially more indolent subgroup of bile duct cancer. This is a detailed report of a successfully resected recurrent bile duct cancer, for which the patient underwent major hepatectomy as a salvage procedure after pancreatoduodenectomy for the primary tumor. An aggressive surgical approach will be a rational treatment of choice for recurrent disease when metachronous multicentric tumor development in the bile duct is suspected and curative resection can be safely performed.

A clinicopathological study on recurrence of bile duct cancer at PTBD tract

A clinicopathological study on recurrence of bile duct cancer at PTBD tract

MUCUS PRODUCING INTRAHEPATIC BILE DUCT CARCINOMA RECURRED IN THE PTCD FISTULA -REPORT OF A CASE-

Percutaneous transhepatic cholangiodrainage (PTCD) and percutaneous transhepatic choledochoscopy (PTCS) can be employed as preoperative diagnosis of bile duct cancer, when caution should be exercised to posibble complications including intrahepatic hemangioma, choleperitonitis, peritonitis carcinomatosa, and implantation of cancer cells. This time we experienced a case of mucus producing bile duct carcinoma recurred in the PTCD fistula. A 51-year-old woman underwent preoperative PTCD with a diagnosis of intrahepatic bile duct cancer. On the 34th day after hepatectomy or 49th day after a PTCD tube was inserted, an induration was felt in subcutaneous tissue at the fistula which was the same site as the PTCD tube was inserted. With a diagnosis of recurrence to the subcutaneous tissue at the PTCD fistula, the tumor was excised. Histopathological findings of the site was the same as those of intrahepatic bile duce carcinoma. However, on the 150th day after the PTCD tube was inserted, another induration was felt at the same site. It was diagnosed as re-recurrence, and an excision of the tumor and associated resection of the 7 and 8th libs and diaphragm were performed. In a review of the literature, recurrence of bile duct cancer to the PTCD fistula is rare, but there may arise some future problem in the management of PTCD.