[Palliative therapy in cholangio- and gallbladder carcinoma]

Area of Science:

• Oncology
• Gastroenterology

Context:

• Non-resectable cholangiocarcinoma and gallbladder carcinoma present significant therapeutic challenges with poor prognoses.
• Malignant biliary stenosis necessitates palliative interventions, including biliary drainage, as part of best supportive care.

Purpose:

• To review current palliative treatment modalities for advanced cholangiocarcinoma and gallbladder carcinoma.
• To evaluate the efficacy and evidence supporting various interventions such as photodynamic therapy, radiation, chemotherapy, and ablative therapies.

Summary:

• Photodynamic therapy has demonstrated improved median survival in hilar cholangiocarcinoma based on controlled studies.
• The survival benefits of external radiation and intraluminal brachytherapy remain inconclusive.
• Systemic chemotherapy's role is debated, though some studies show survival benefits, and new protocols are emerging with promising results.
• Intra-arterial chemotherapy and chemotherapeutically coated stents require further evaluation before recommendation.
• Ablative therapies have been used sparingly, necessitating further research.

Impact:

• Highlights the current limitations and uncertainties in managing advanced biliary tract cancers.
• Identifies areas requiring further clinical investigation to establish effective palliative treatment strategies.
• Provides a concise overview of evidence-based and investigational therapies for oncologists and gastroenterologists.