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Topics:
Radiation Oncology • Gastrointestinal Cancers • Medical Oncology • Liver and Pancreas Tumors • Cholangiocarcinoma
In patients with perihilar cholangiocarcinoma eligible for liver transplant, what is the protocol for neoadjuvant chemo-RT, particularly when brachytherapy is not available?
The Mayo Clinic protocol recommends initial fields -1.5 Gy BID initially to 45 Gy followed by a Brachytherapy boost. If HDR /LDR is not available, what dose fractionation would you recommend as a boost with EBRT?
Answer from: Radiation Oncologist at Academic Institution
There is a lot of variability in neoadjuvant regimens prior to transplant for hilar cholangiocarcinoma as outlined in the survey paper above. Institutional approaches for total dose, fractionation, and target volumes vary considerably.
A couple of points to consider and some personal opinions - Phi...
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Answer from: Radiation Oncologist at Academic Institution
Looking forward to hearing expert opinions on this, until then this is a nice paper from Drs. @Keltner and @Kharofa at the University of Cincinnati reporting practice patterns of Neoadjuvant Therapy Regimens for Hilar Cholangiocarcinoma Before Liver Transplant. Table 2 lists the dose and fractionati...
Answer from: Radiation Oncologist at Community Practice
Just as @Chris Fleming has suggested, there is considerable practice variation in this space and it’s nicely summarized in the study by Dr. @Keltner et al., PMID 37036238.For patients who are not brachy candidates or brachy is not successful for various technical reasons, following the initial...