title: Aggressive surgical resection after neoadjuvant chemoradiation therapy for locally advanced intrahepatic cholangiocarcinoma.
abstract: The poor prognosis of patients with intrahepatic cholangiocarcinoma (ICC) or hilar cholangiocarcinoma is well known. Herein, we described the first reported case of severe locally advanced ICC in which radical surgery was successfully achieved based on the marked effect of neoadjuvant chemoradiation therapy (NCRT) using gemcitabine. A 54-year-old man was admitted to our institution with obstructive jaundice. Abdominal computed tomography (CT) showed a large low-density mass in the caudate lobe, extensively involving the inferior vena cava and main portal vein. Moreover, nodal involvements of the hepatoduodenal ligament were detected concurrently. We therefore regarded this tumor as a severe locally advanced ICC and attempted to initiate combined treatment with gemcitabine (800 mg/m(2) biweekly) and three-dimensional conformation radiation (45 Gy/25 days). After completion of NCRT, this patient underwent a left trisegmentectomy with combined resection of the portal vein and inferior vena cava. Postoperative microscopic findings surprisingly revealed that more than 90% of tumor cells had disappeared with extensive fibrosis, achieving tumor downstaging and tumor volume reduction which were related to the radical resection. In conclusion, ICC showed a favorable histological response to chemoradiation therapy using gemcitabine. Further studies are needed to conclusively assess the effect of NCRT on locally advanced ICC.
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan. kato0719@clin.medic.mie-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohsawa
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kishiwada
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
keywords: Gemcitabine; Intrahepatic cholangiocarcinoma; Neoadjuvant chemoradiation therapy