Research advances in palliative treatment of cholangiocarcinoma
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摘要: 虽然根治性切除是胆管癌唯一的治愈方法,但是疾病诊断时患者大多已是晚期,错过了最佳手术时机。以重建胆汁引流为中心的姑息治疗能改善患者的生活质量,延长生存期。介绍了近年来胆管癌姑息性治疗的最新进展,胆道支架放置术、姑息性手术等都能使患者获益,局部和全身的辅助治疗也不可或缺,如放疗、化疗、光动力学治疗、免疫治疗等,但是其确切疗效还有待进一步研究。随着基础研究和医疗技术的不断发展,传统的治疗方法将不断改进,针对胆管癌发病机制的新型治疗方法也将发挥重要作用,共同造福广大患者。Abstract: Although radical resection is the only method to cure cholangiocarcinoma,most patients are in the advanced stage at the time of diagnosis and miss the best time for surgery. The palliative treatment focusing on biliary drainage reconstruction can improve patients' quality of life and prolong survival time. This article introduces the latest advances in palliative treatment for cholangiocarcinoma in recent years. Patients can benefit from the treatment methods such as biliary stenting and palliative surgery. Local and systemic adjuvant therapies are also indispensible,such as radiotherapy,chemotherapy,photodynamic therapy,and immunotherapy,but their therapeutic effects await further investigation. With the continuous development of basic research and medical techniques,the traditional therapeutic methods will be constantly improved. The new therapeutic methods targeting the pathogenesis of cholangiocarcinoma will also play an important role and bring benefits to the patients.
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Key words:
- bile duct neoplasms /
- palliative care /
- stents /
- radiotherapy /
- drug therapy /
- review
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[1]PARODI A,FISHER D,GIOVANNINI M,et al.Endoscopic management of hilar cholangiocarcinoma[J].Nat Rev Gastroenterol Hepatol,2012,9(2):105-112. [2]RAZUMILAVA N,GORES GJ.Cholangiocarcinoma[J].Lancet,2014,383(9935):2168-2179. [3] SHARIFF MI,KHAN SA,WESTABY D.The palliation of cholangiocarcinoma[J].Curr Opin Support Palliat Care,2013,7(2):168-174. [4]BLECHACZ B,GORES GJ.Cholangiocarcinoma:advances in pathogenesis,diagnosis,and treatment[J].Hepatology,2008,48(1):308-321. [5]SMITH AC,DOWSETT JF,RUSSELL RC,et al.Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction[J].Lancet,1994,344(8938):1655-1660. [6]DEVIERE J,BAIZE M,DE TJ,et al.Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage[J].Gastrointest Endosc,1988,34(2):95-101. [7]de PALMA GD,GALLORO G,SICILIANO S,et al.Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction:results of a prospective,randomized,and controlled study[J].Gastrointest Endosc,2001,53(6):547-553. [8]RERKNIMITR R,ANGSUWATCHARAKON P,RATANACHUEK T,et al.Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J].J Gastroenterol Hepatol,2013,28(4):593-607. [9]HWANG JC,KIM JH,LIM SG,et al.Y-shaped endoscopic bilateral metal stent placement for malignant hilar biliary obstruction:prospective long-term study[J].Scand J Gastroenterol,2011,46(3):326-332. [10]SINGHAL D,van GULIk TM,GOUMA DJ.Palliative management of hilar cholangiocarcinoma[J].Surg Oncol,2005,14(2):59-74. [11]FREEMAN ML,SIELAFF TD.A modern approach to malignant hilar biliary obstruction[J].Rev Gastroenterol Disord,2003,3(4):187-201. [12]MOSS AC,MORRIS E,LEYDEN J,et al.Do the benefits of metal stents justify the costs?A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction[J].Eur J Gastroenterol Hepatol,2007,19(12):1119-1124. [13]RAJU RP,JAGANMOHAN SR,ROSS WA,et al.Optimum palliation of inoperable hilar cholangiocarcinoma:comparative assessment of the efficacy of plastic and self-expanding metal stents[J].Dig Dis Sci,2011,56(5):1557-1564. [14]ISAYAMA H,KOMATSU Y,TSUJINO T,et al.A prospective randomised study of‘covered’versus‘uncovered’diamond stents for the management of distal malignant biliary obstruction[J].Gut,2004,53(5):729-734. [15]SALEEM A,LEGGETT CL,MURAD MH,et al.Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction[J].Gastrointest Endosc,2011,74(2):321-327. [16]PARK DH,SONG TJ,EUM J,et al.EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP(with videos)[J].Gastrointest Endosc,2010,71(2):413-419. [17]YAMAO K,BHATIA V,MIZUNO N,et al.Interventional endoscopic ultrasonography[J].J Gastroenterol Hepatol,2009,24(4):509-519. [18]SHARIFF MI,KHAN SA,WESTABY D.The palliation of cholangiocarcinoma[J].Curr Opin Support Palliat Care,2013,7(2):168-174. [19]STEEL AW,POSTGATE AJ,KHORSANDI S,et al.Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction[J].Gastrointest Endosc,2011,73(1):149-153. [20]XU HX,WANG Y,LU MD,et al.Percutaneous ultrasoundguided thermal ablation for intrahepatic cholangiocarcinoma[J].Br J Radiol,2012,85(1016):1078-1084. [21]PARK SY,KIM JH,YOON HJ,et al.Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma[J].Clin Radiol,2011,66(4):322-328. [22]KUHLMANN JB,EURINGER W,SPANGENBERG HC,et al.Treatment of unresectable cholangiocarcinoma:conventional transarterial chemoembolization compared with drug eluting beadtransarterial chemoembolization and systemic chemotherapy[J].Eur J Gastroenterol Hepatol,2012,24(4):437-443. [23]BERR F.Photodynamic therapy for cholangiocarcinoma[J].Semin Liver Dis,2004,24(2):177-187. [24]ORTNER ME,CACA K,BERR F,et al.Successful photodynamic therapy for nonresectable cholangiocarcinoma:a randomized prospective study[J].Gastroenterology,2003,125(5):1355-1363. [25]NOWIS D,STOKLOSA T,LEQAT M,et al.The influence of photodynamic therapy on the immune response[J].Photodiag photodyn Ther,2005,2(4):283. [26]ISAYAMA H,TSUJINO T,NAKAI Y,et al.Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma[J].World J Gastroenterol,2012,18(19):2364-2370. [27]GERHARDS MF,van GULIK TM,GONZA'LEZ GONZA'LEZ D,et al.Result of postoperative radiotherapy for resectable hilar cholangiocarcinoma[J].World Surg,2003,27(2):173-179. [28]ZHU HD,GUO JH,Zh U GY,et al.A novel biliary stent loaded with(125)I seeds in patients with malignant biliary obstruction:preliminary results versus a conventional biliary stent[J].J Hepatol,2012,56(5):1104-1111. [29]VALLE J,WASAN H,PALMER DH,et al.Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer[J].N Engl J Med,2010,362(14):1273-1281. [30]CHEN JS,HSU C,CHIANG NJ,et al.AKRAS mutation statusstratified randomized phase II trial ofgemcitabine and oxaliplatin alone or in combination with cetuximab in advanced biliary tract cancer[J].Ann Oncol,2015,26(5):943-949. [31]MARKS EI,YEE NS.Immunotherapeutic approaches in biliary tract carcinoma:Current status and emerging strategies[J].World J Gastrointest Oncol,2015,7(11):338-346. [32]KOIDO S,KAN S,YOSHIDA K,et al.Immunogenic modulation of cholangiocarcinoma cells by chemoimmunotherapy[J].Anticancer Res,2014,34(11):6353-6361. [33]ARUGA A,TAKESHITA N,KOTERA Y,et al.Phase I clinical trial of multiple-peptide vaccination for patients with advanced biliary tract cancer[J].J Transl Med,2014,12(1):1-11.
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