ROCHESTER, Minn. -- A new treatment for patients with a type of bile duct cancer
promises a greater chance at survival by combining radiation, chemotherapy and
liver transplantation, Mayo Clinic physicians report in the September issue of
the Annals of Surgery.

The five-year survival rate for patients who received a liver transplant after
radiation and chemotherapy was 82 percent, significantly higher than for those
who had a conventional operation. "With the combined benefits of radiation,
chemotherapy and liver transplantation, our patients with bile duct cancer now
have a much better chance to live longer and enjoy a good quality of life," says
Charles Rosen, M.D., a Mayo Clinic transplant surgeon and co-author of the
study.

Conventional therapy for hilar cholangiocarcinoma, a type of bile duct cancer,
is to remove (resect) the tumor, which may require removing part of the liver.
Survival for patients with this type of operation is only 25 to 35 percent, and
many patients cannot be treated this way because the tumors can involve both
sides of the liver. Combination therapy with liver transplantation is possible
for more patients. Transplantation enables surgeons to remove the entire liver
and obtain better tumor clearance. Patients treated with transplantation have
enjoyed a higher likelihood of prolonged survival than those treated with the
conventional operation.

To improve results of liver transplantation for unresectable hilar
cholangiocarcinoma, Mayo Clinic physicians developed a treatment protocol
combining radiation therapy, chemotherapy and liver transplantation. Patients
receive high dose external beam radiation therapy, followed by high dose
irradiation with iridium administered through a catheter passing through the
bile duct and tumor. Chemotherapy starts during radiation treatment and
continues until transplantation. Prior to transplantation, patients undergo a
staging abdominal operation so surgeons can look for any spread of the tumor to
lymph nodes or the abdomen that would prevent complete tumor removal.

Mayo Clinic's liver transplant team has treated over 90 patients with hilar
cholangiocarcinoma. Approximately one-third of the patients have findings at the
staging operation that preclude subsequent transplantation, but this number may
be decreasing with earlier diagnosis and referral for treatment. Sixty patients
have undergone liver transplantation -- many recently with living donors -- and
results remain superb, says Dr. Rosen.

Cholangiocarcinoma is a relatively uncommon malignant tumor that is often found
in the lining of the bile duct. In the United States, the most common risk
factor is sclerosing cholangitis, a chronic liver disease characterized by
inflammation, destruction and fibrosis of the bile ducts, often leading to
cirrhosis of the liver. The cancer also is seen in patients with con{*filter*} bile
duct cysts and bile duct stones. Most frequently, these tumors are located near
the liver. Cholangiocarcinomas in this location are difficult to treat because
the tumor often extends deep into the liver in a way that it cannot be
completely removed with a conventional operation.

The incidence of bile duct cancer is increasing in the United States, according
to Gregory Gores, M.D., Mayo Clinic liver transplant specialist and co-author of
the study. Mayo Clinic has ongoing research into new tests to diagnose the tumor
earlier, which could lead to even better results.

"The major problem is that we still don't have enough livers for everyone who
needs one," says Dr. Rosen. "We feel that patients with cholangiocarcinoma
should have equal access to donor organs, because the results are comparable to
those achieved for other patients who undergo transplantation. Without a
transplant, the outlook for these patients is fairly poor."

Other Mayo Clinic physician researchers involved with this study include: David
Rea, M.D., Julie Heimbach, M.D., Michael Haddock, M.D., Steven Alberts, M.D.,
Walter Kremers, Ph.D., and David Nagorney, M.D.

To obtain the latest news releases from Mayo Clinic, go to
www.mayoclinic.org/news. MayoClinic.com (www.mayoclinic.com) is available as a
resource for your health stories.

Alan

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