What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?  

For perihilar cholangiocarcinoma that has been deemed unresectable by hepatobiliary surgeons, a good consideration is to have the patient evaluated for liver transplantation. The Mayo Clinic protocol allows tumor mass of <3cm, no nodal disease, and vascular involvement is allowed. Depending on th...

It's sad to me to see institutions such as the Mayo Clinic (when Len Gunderson was in charge---using intraoperative XRT and intrabiliary implants) and Johns Hopkins (when hepatobiliary surgeon John Cameron almost always had his patients receive postop XRT or primary XRT), pioneers in radiation thera...

I treat them as I would metastatic patients.The TOPAZ-1 regimen can be considered, as can gemcitabine, cisplatin, and abraxane based on phase II data, the latter especially if I think there is any hope of getting the patient downstaged and to surgery.

The treatment of peri-hilar (h-CCA) cholangiocarcinoma is an evolving field with continuous development of radiological and surgical techniques ranging from traditional hepatectomies to complex approaches involving preoperative portal vein embolization or associating liver partition and portal vein ...