title: Neoadjuvant chemoradiotherapy followed by liver transplantation for unresectable cholangiocarcinoma: a single-centre national experience.
abstract: BACKGROUND
  Unresectable cholangiocarcinoma (CCA) has a dismal prognosis. Initial studies of orthotopic liver transplantation (OLT) alone for CCA yielded disappointing outcomes. The Mayo Clinic demonstrated long-term survival using neoadjuvant chemoradiotherapy followed by OLT in selected patients with unresectable CCA. This study reports the Irish National Liver Transplant Programme experience of neoadjuvant therapy and OLT for unresectable CCA.
  
  
  METHODS
  Twenty-seven patients with CCA were selected for neoadjuvant chemoradiotherapy in a single centre from October 2004 to September 2011. Patients were given brachytherapy, external beam radiotherapy and 5-fluorouracil (5-Fu), followed by liver transplantation if progression free (20 patients).
  
  
  RESULTS
  Twenty progression-free patients after neoadjuvant therapy underwent OLT. Hospital mortality was 20%. Of the 16 patients who left hospital, survival rates were 94% and 61% at 1 and 4 years. Seven patients developed recurrent disease and died at intervals of 10-58 months after OLT, whereas 9 are disease free with a median follow-up of 37 months (18-76). Predictors of disease recurrence were a tumour in explant specimen and high CA 19.9 levels.
  
  
  CONCLUSIONS
  In selected patients with unresectable CCA, long-term survival can be achieved using neoadjuvant chemoradiotherapy and OLT although short-term mortality is high. Prospective international registries may aid patient selection and refinement of neoadjuvant regimens.
authors.affiliation: National Liver Transplant Programme, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Duignan
authors.forename: Donal
authors.initials: D
authors.lastname: Maguire
authors.forename: Chamarajanagar S
authors.initials: CS
authors.lastname: Ravichand
authors.forename: Justin
authors.initials: J
authors.lastname: Geoghegan
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.forename: David
authors.initials: D
authors.lastname: Fennelly
authors.forename: John
authors.initials: J
authors.lastname: Armstrong
authors.forename: Kathy
authors.initials: K
authors.lastname: Rock
authors.forename: Helen
authors.initials: H
authors.lastname: Mohan
authors.forename: Oscar
authors.initials: O
authors.lastname: Traynor
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D001918:Brachytherapy; D018395:CA-19-9 Antigen / Q000097:blood; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D018281:Cholangiocarcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D007494:Ireland; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D010865:Pilot Projects; D015397:Program Evaluation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D018395:CA-19-9 Antigen; D005472:Fluorouracil