| セッション情報 | パネルディスカッション16(消化器外科学会・消化器病学会・消化器内視鏡学会合同)進行胆道癌に対する集学的治療の標準化に向けて |
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| タイトル | PD16-基調講演1：Multidisciplinary Treatment of Hilar Cholangiocarcinoma |
| 演者 | C. B. Rosen（Mayo Clinic） |
| 共同演者 | |
| 抄録 | Background: Mayo Clinic developed a multidisciplinary treatment protocol designed for patients with unresectable hilar cholangiocarcinoma (CCA) and CCA arising in the setting of primary sclerosing cholangitis (PSC). The protocol includes strict selection criteria; neoadjuvant therapy (high dose external beam radiotherapy, brachytherapy and chemosensitization); operative staging to rule-out metastases; and liver transplantation. Aim: To demonstrate efficacy. Method: Review of Mayo Clinic and multicenter results. Results: Mayo Clinic Rochester treated 237 patients with neoadjuvant therapy with the intention to proceed with transplantation between 1993 and 2013. All patients had CCA arising in the setting of PSC or unresectable CCA arising de novo. Patient survival 5 years after start of therapy was 64 ± 4% for 141 patients with CCA arising in PSC and 39 ± 6% for 96 patients with CCA arising de novo. 153 patients underwent transplantation, and 5-year survival after transplantation was 81 ± 4% for 96 patients with CCA arising in PSC and 58 ± 7% for 57 patients with CCA arising de novo. These results have been corroborated by a multicenter study in the US. Conclusion: Neoadjuvant therapy followed by liver transplantation is effective treatment for CCA. Neoadjuvant therapy completely eradicates the tumor in about half of the patients, prevents progression while awaiting transplantation, and may prevent dissemination during surgery. Staging rules-out patients with metastases destined to have recurrence after transplantation, and transplantation removes residual disease with a radical resection. Potential problems with high dose radiotherapy are obviated by replacement of the liver during transplantation. |
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