Intraductal Therapies for Cholangiocarcinoma

Abhishek Agnihotri, David E. Loren

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts with a rising incidence and high mortality. CCA often presents with advanced disease limiting the possibility of curative resection and/or liver transplantation. Alleviating biliary obstruction is a dominant component to improving outcomes, which can be achieved with effective mechanical decompression combined with ablative treatments including photodynamic therapy (PDT), radiofrequency ablation (RFA) and intraluminal brachytherapy (ILBT). The goals for most patients are to mitigate the effects of biliary obstruction and complications of jaundice, cholangitis and liver failure, factors that are associated with decreased quality of life and shortened survival. Therapeutic decisions are made with attention to the extent and location of disease, intent of therapy, and individual patient considerations. PDT involves systemic infusion of a photosensitizer chemical which is preferentially taken up by neoplastic tissue followed by exposure to laser resulting in targeted cell death. PDT in conjunction with stenting improves overall survival and stent patency. Notable risks include photosensitivity, cholangitis, liver abscess, and hemobilia. RFA uses high frequency alternating current to produce heat leading to local ablation with coagulative necrosis of tissue adjacent to the RFA probe. Limited data show improved stent patency and overall survival with a reasonable safety profile. There are limited data on intraluminal brachytherapy which highlight its role in improving survival by delivering high dose local radiation therapy most commonly as part of a neoadjuvant strategy for liver transplantation in select patients with CCA. For such patients the endoscopic approach may reduce risk of tumor seeding compared to transcutaneous approach.

Original languageEnglish
Pages (from-to)200-210
Number of pages11
JournalTechniques and Innovations in Gastrointestinal Endoscopy
Volume24
Issue number2
DOIs
StatePublished - Jan 2022
Externally publishedYes

Keywords

  • Brachytherapy
  • Cholangiocarcinoma
  • Photodynamic therapy
  • Radiofrequency ablation

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