title: Neoadjuvant therapy for downstaging of locally advanced hilar cholangiocarcinoma: a systematic review.
abstract: BACKGROUND
  Hilar cholangiocarcinoma is a rare but highly lethal type of cancer. A minority of patients present with resectable disease. Surgery remains the only treatment modality offering a chance of long-term survival. Unresectable patients are typically offered palliative treatment. The aim of this systematic review was to summarize the evidence for neoadjuvant therapy followed by surgical resection in patients presenting with hilar cholangiocarcinoma.
  
  
  METHODS
  Cochrane databases, Medline, PubMed and EMBASE were systematically searched to identify articles describing neoadjuvant therapy and surgical resection or re-assessment of resectability in patients with hilar cholangiocarcinoma. Included were all articles with original research. Study selection and data extraction were performed separately by two reviewers using a standardized protocol.
  
  
  RESULTS
  From 732 articles 8 full text articles and 2 abstracts met the inclusion criteria. The 2 abstracts and 1 full text article were case reports, 3 articles were retrospective and 4 were prospective studies (2 phase I and 2 phase II studies). Photodynamic therapy, chemotherapy and radiation therapy were used in various indications in populations that included patients with hilar cholangiocarcinoma, some of which were primarily unresectable. Overall quality of articles was limited.
  
  
  CONCLUSIONS
  Current evidence suggests that neoadjuvant therapy in patients with unresectable hilar cholangiocarcinoma can be performed safely and in a selected group of patients can lead to subsequent surgical R0 resection. Surgical resection of downstaged patients should be assessed in properly designed phase II studies.
authors: Department of Surgery, University of Calgary, Calgary, AB, Canada.
authors: Jan
authors: J
authors: Grendar
authors: Petra
authors: P
authors: Grendarova
authors: Richie
authors: R
authors: Sinha
authors: Elijah
authors: E
authors: Dixon
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010778:Photochemotherapy; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
references: Liver Transpl. 2012 May;18(5):594-601
references: 22140024
references: Ann Surg. 1996 Oct;224(4):463-73; discussion 473-5
references: 8857851
references: Ann Surg. 2006 Aug;244(2):230-9
references: 16858185
references: Ann Surg Oncol. 2007 Nov;14(11):3202-9
references: 17705089
references: Arch Surg. 2004 May;139(5):514-23; discussion 523-5
references: 15136352
references: Ann Oncol. 2006 Jun;17 Suppl 7:vii68-72
references: 16760298
references: J Hepatobiliary Pancreat Surg. 2008;15(1):55-62
references: 18274844
references: Liver Transpl. 2000 May;6(3):309-16
references: 10827231
references: Nat Clin Pract Gastroenterol Hepatol. 2006 Jan;3(1):33-42
references: 16397610
references: World J Gastroenterol. 2009 Sep 14;15(34):4240-62
references: 19750567
references: Int J Cancer. 2012 May 1;130(9):2155-63
references: 21387295
references: Can J Gastroenterol. 2010 Jan;24(1):52-7
references: 20186357
references: Gastroenterology. 2003 Nov;125(5):1355-63
references: 14598251
references: J Gastrointest Surg. 2012 Sep;16(9):1666-71
references: 22777053
references: Gan To Kagaku Ryoho. 2012 Aug;39(8):1279-82
references: 22902459
references: Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):148-53
references: 18805651
references: Dig Surg. 1999;16(3):209-13
references: 10436369
references: Am J Gastroenterol. 2005 Nov;100(11):2426-30
references: 16279895
references: Am J Surg. 1997 Dec;174(6):605-8; discussion 608-9
references: 9409582
references: Ann Surg. 2007 May;245(5):755-62
references: 17457168
references: Expert Opin Emerg Drugs. 2007 Nov;12(4):571-89
references: 17979600
references: Ann Surg Oncol. 2009 Jan;16(1):14-22
references: 18987916
references: Ann Surg. 2003 Jul;238(1):84-92
references: 12832969
references: Ann Surg. 2005 May;241(5):693-9; discussion 699-702
references: 15849505
references: Gastroenterology. 2005 May;128(6):1655-67
references: 15887157
references: Semin Liver Dis. 2004 May;24(2):201-7
references: 15192792
references: Cancer. 2003 Jun 1;97(11):2783-90
references: 12767091
references: Hepatogastroenterology. 2011 Nov-Dec;58(112):1866-72
references: 22234055
references: World J Surg. 2007 Jun;31(6):1256-63
references: 17453285
references: J Clin Epidemiol. 2009 Oct;62(10):e1-34
references: 19631507
references: Eur J Surg Oncol. 2000 Aug;26(5):480-5
references: 11016470
references: Surgery. 2006 Sep;140(3):331-4
references: 16934588
references: Ann Surg. 2001 Oct;234(4):507-17; discussion 517-9
references: 11573044
references: Semin Liver Dis. 1994 May;14(2):109-14
references: 8047893
references: Ann Surg Oncol. 2006 Jun;13(6):872-80
references: 16614876
references: J Hepatol. 2000 Feb;32(2):352-7
references: 10707878