Patient's eligible for the Mayo Clinical protocol to treat hilar cholangiocarcinoma do NOT include:
Cholangiocarcinoma is an adenocarcinoma of the bile ducts, and represents the second most common primary liver malignancy. Cholangiocarcinoma may be intra- or extrahepatic, and the latter may be divided into proximal or distal. Proximal cholangiocarcinoma is also known as hilar cholangiocarcinoma or Klatskin tumor. The only curative treatment option for hilar cholangiocarcinoma is surgical resection, for which the reported 5-year survival rates range from 25 to 40%. However, in the presence of primary sclerosing cholangitis (PSC, - 1 0% of patients with cholangiocarcinoma), the results of surgical resection are poor due to associated liver dysfunction and portal hypertension. For this reason, the Mayo Clinic protocol was developed to treat patients with hilar cholangiocarcinoma and PSC. This treatment comprises external beam radiation, 5-FU-based chemotherapy, and iridium - 192 brachytherapy followed by operative staging and OLT in patients without metastatic disease. The 5-year survival rate for patients completing this protocol is 70%. Current eligibility criteria for this protocol include patients with hilar cholangiocarcinoma with PSC or patients with unresectable hilar cholangiocarcinoma who have not received prior radiotherapy. Furthermore, the patient must have a primary tumor less than 3 em in radial dimension and no evidence of intrahepatic or extrahepatic metastases.
A patient undergoes routine cholecystectomy and is incidentally found to have gallbladder carcinoma that is staged as Tl. Further treatment should include:
Gallbladder cancer is a rare and aggressive form of biliary malignancy. In approximately one-third of cases it is diagnosed incidentally following routine cholecystectomy. Treatment for these patients is guided by T stage of the tumor. In those patients with Tl tumors, no further treatment is necessary. In patients with T2 or greater tumors, reoperation with central liver resection and hilar lymphadenectomy is recommended. The role for more radical resections is unclear.
Which of the following is considered a primary determinant of suitability for resection when evaluating a patient with hepatic colorectal metastases?
The liver is a common site for metastatic disease in patients with colorectal disease, and approximately 50 to 60% of patients diagnosed with colorectal cancer will develop liver metastases within their lifetime. With the advent of more aggressive strategies for the management of metastatic colorectal cancer, including improved chemotherapeutic regimens and expanded use of metastasectomy, the 5-year survival for patients with isolated metastases to the liver may exceed 30%. Given these encouraging results, the paradigm for surgical evaluation and treatment of these patients has shifted to primarily consider the health of the background liver and volume of the hepatic remnant, and not tumor characteristics such as size and number.
Based on the standard Milan criteria, which of the following patients with HCC would be eligible for transplantation?
OTL was first attempted in the 1980s and 1990s, with initial series reporting 5-year survival rates of 20 to 50%. This led to the introduction of the Milan criteria which limited eligibility to patients with one tumor less than 5 em or up to three tumors less than 3 em and no evidence of gross intravascular or extrahepatic spread. Adoption of these guidelines resulted in significant improvement in 5-year survival for patients with HCC treated with OTL.
The only FDA-approved systemic chemotherapeutic agent for HCC is:
Though systemic chemotherapy has not proven very effective in the treatment of HCC, the multikinase inhibitor sorafenib has been approved for use specifically in these patients. Based on results of the SHARP trial, the sorafenib demonstrated a 3-month survival benefit versus placebo. Though these results are modest, it remains a treatment option for patients with advanced, unresectable HCC.
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