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Liver

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Room: E-Poster Hall

P-12.71 Liver transplantation with neoadjuvant chemoradiation for treatment of unresectable hilar cholangiocarcinoma. An European series.

CRISTINA DOPAZO, Spain

CONSULTANT SURGEON
DEPARTMENT OF HPB SURGERY AND TRANSPLANTS
HOSPITAL UNIVERSITARIO VALL D´HEBRON, UNIVERSIDAD AUTONOMA DE BARCELONA

Abstract

Liver transplantation with neoadjuvant chemoradiation for treatment of unresectable hilar cholangiocarcinoma. An European series.

Cristina Dopazo1, Laura Llado2, Amelia Hessheimer3, Fondevila Constantino3, Macarulla Teresa4, Begona Navalpotro5, Emilio Ramos2, Joan Fabregat2, Blanca Laquente6, Miquel Navasa7, Itxarone Bilbao1, Ramon Charco1.

1Department of HPB Surgery and Transplants, Hospital Universitario Vall D’Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain; 2Department of HPB Surgery and Transplants, Hospital Universitario de Bellvitge, Barcelona, Spain; 3Department of HPB Surgery and Transplants, Hospital Clinic, Barcelona, Spain; 4Department of Oncology, Hospital Universitario Vall D’Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain; 5Department of Radiation Oncology, Hospital Universitario Vall D’Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain; 6Department of Oncology, Hospital Universitario de Bellvitge, Barcelona, Spain; 7Hepatology Unit, Hospital Clinic, Barcelona, Spain

Background: In 2007, a multicenter protocol was developed in Catalonia, Spain, combining neoadjuvant chemoradiotherapy and liver transplantation (LT) for those patients with unresectable hilar cholangiocarcinoma (hCCA).
Aim: To analyse the effectiveness of the neoadjuvant chemoradiotherapy and LT for those patients enrolled in the protocol based on intention-to-treat.
Methods: Observational prospective multicenter study which includes patients ≤ 68 years-old diagnosed with unresectable, solitary tumors ≤3cm in radial diameter, without evidence of lymph node metastases. The protocol was based on a strategy of neoadjuvant therapy with high-dose radiation (45Gy in total) plus intravenous fluorouracil (5-FU) given as a daily bolus for the first 3 days of radiation follow by oral capecitabine until transplantation.  The patient was included in waiting list for LT after operative staging if no evidence of disseminated disease was found.
Results: Between 2007 and 2018, 13 patients were enrolled in the transplant protocol. Three patients dropped out before LT: two cases due to disease progression and one death because of recurrent cholangitis. Two cases were excluded at the moment of LT based on previously undetected tumor progression. Finally, 61% (8/13) of the patients were transplanted. The average time spent on the waiting list was 122 days (range 5-192). Intent-to-treat survival was 62% and 39% at one and 5 years. Post-transplantation overall survival was 75% and 62% and 42% recurrence rate at 5 years.
Conclusion: The effectiveness of the neoadjuvant chemoradiotherapy and LT protocol was 61% in our series with a high rate of post-transplantation recurrence-free survival after 5 years and should be considered as an alternative to resection for patients with localized node-negative hCCA.

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