ABSTRACT
Abstract: Introduction and aims. Cholangiocarcinomas are a heterogeneous group of tumors that can be classified into three clinically distinct types of cancers, intrahepatic, perihilar and distal cholangiocarcinoma. The inconsistent use of nomenclature for these cancers has obscured a true knowledge of the epidemiology, natural history and response to therapy of these cancers. Our aims were to define demographic characteristics, management and outcomes of these three distinct cancer types. Materials and methods. A retrospective study of patients enrolled in an institutional cancer registry from 1992 to 2010. Median survival was compared between different treatment modalities over three time periods for the three types of cholangiocarcinoma at different stages of the disease using Kaplan Meyer analysis. Results. 242 patients were identified. All cases were reviewed and classified into intrahepatic (90 patients), distal (48 patients) or perihilar (104 patients) cholangiocarcinomas. These cancers differed in median age of onset, gender distribution, median survival and stage. 13.8% of patients presented with stage I, 5.8% with stage II, 9.6% with stage III, 28% with stage IV, with 41.8% having unknown stage. The overall median survival was 15.8 months, and was 23, 25, 14, and 4.5 months for stages I, II, III, and IV respectively. Surgery improved survival in both early and advanced stages. Multimodality therapies further improved outcomes, particularly for perihilar cholangiocarcinoma. Conclusion. Perihilar, distal and intrahepatic cholangiocarcinoma vary in their presentation, natural history and therapeutic approach to management. A consistently applied classification is essential for meaningful interpretation of studies of these cancers.
Subject(s)
Humans , Middle Aged , Aged , Bile Duct Neoplasms/therapy , Biliary Tract Surgical Procedures , Cholangiocarcinoma/therapy , Antineoplastic Agents/therapeutic use , Time Factors , Bile Duct Neoplasms/classification , Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/pathology , Biliary Tract Surgical Procedures/adverse effects , Biliary Tract Surgical Procedures/mortality , Registries , Florida , Retrospective Studies , Treatment Outcome , Chemotherapy, Adjuvant , Klatskin Tumor/classification , Klatskin Tumor/mortality , Klatskin Tumor/pathology , Klatskin Tumor/therapy , Cholangiocarcinoma/classification , Cholangiocarcinoma/mortality , Cholangiocarcinoma/pathology , Radiotherapy, Adjuvant , Kaplan-Meier Estimate , Neoplasm Staging , Antineoplastic Agents/adverse effectsABSTRACT
This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett's esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting.