Excellent clinical outcomes can be achieved with neoadjuvant chemoradiation and orthotopic liver transplantation for unresectable cholangiocarcinoma: support for the need of an international transplant protocol

[摘要] We thank Dr. He et al. for their comments regarding our retrospective study evaluating treatment strategies in the management of hilar and extrahilar cholangiocarcinoma, published in Journal of Gastrointestinal Oncology (1). The combination of neoadjuvant chemoradiation followed by orthotopic liver transplantation via an institutionalbased strict protocol/selection process provides the best outcomes for these patients. This has been well validated (2-5). Ultimately, eligibility for this protocol is rigorous: patients may not have metastatic disease, tumor size >3 cm, or medical conditions that would preclude transplant (2,3). Patients with a malignant stricture in the setting of primary sclerosing cholangitis are also eligible (2,3). For several different reasons, approximately 25% of patients who initiate protocol-based therapy become ineligible to proceed with liver transplantation (6). It is important to note that patients with unresectable disease who undergo this protocol may have superior outcomes compared to patients with resectable disease who undergo surgical resection followed by adjuvant therapy (1,6).

[学科分类] 肿瘤学