Surgery is the only treatment for biliary tract cancer with long term survival. Unfortunately, most patients are diagnosed at stage IV with distant metastases. In these circumstances, life expectancy is less than one year due to aggressive tumour biology and a lack of effective systemic therapies. HER2 overexpression or amplification is predominantly seen in extrahepatic cholangiocarcinoma and gallbladder cancer (10–18%) and rarely in intrahepatic cholangiocarcinoma (1%). Trastuzumab is a monoclonal antibody that targets HER-2. We present a clinical case with a stage IV gallbladder cancer (liver and interaortocaval lymph node metastases), which presented progression during first-line chemotherapy treatment, which prompted a change in therapy to study the Her 2/Neu mutation which showed an intense positive overexpression. A combination of HER2/Neu-directed therapy (Trastuzumab) with second-line chemotherapy, was able to achieve a long term complete radiological, metabolic, and biochemical response. A curative intention surgery was performed and the patient is alive and recurrence-free at five years. To the best of our knowledge, we present a case which is the first report of a patient with a Stage IV gallbladder cancer who achieved a five-year survival without recurrence after a conversion therapy combining chemotherapy plus Trastuzumab and radical salvage surgery.
PurposeThe present study aims to assess the results obtained after surgical treatment of cholangiocarcinoma (CC) recurrences.MethodsWe carried out a single-center retrospective study, including all patients with recurrence of CC. The primary outcome was patient survival after surgical treatment compared with chemotherapy or best supportive care. A multivariate analysis of variables affecting mortality after CC recurrence was performed.ResultsEighteen patients were indicated surgery to treat CC recurrence. Severe postoperative complication rate was 27.8% with a 30-day mortality rate of 16.7%. Median survival after surgery was 15 months (range 0-50) with 1- and 3-year patient survival rates of 55.6% and 16.6%, respectively. Patient survival after surgery or CHT alone, was significantly better than receiving supportive care (p< 0.001). We found no significant difference in survival when comparing CHT alone and surgical treatment (p=0.113). Time to recurrence of <1 year, adjuvant CHT after resection of the primary tumor and undergoing surgery or CHT alone versus best supportive care were independent factors affecting mortality after CC recurrence in the multivariate analysis.ConclusionSurgery or CHT alone improved patient survival after CC recurrence compared to best supportive care. Surgical treatment did not improve patient survival compared to CHT alone.
10 case series. The epidemiological data were mostly men in the sixth decade of life. The median time between diagnosis of the primary tumor and hepatic metastases was 46.7 months (range: 0-180). Most CRC metastases are CK7-/ CK20 + (Figure 1 shows histological images). Treatment ranged from endoscopic resection to mayor hepatic resections combined with pancreatectomies. When curative surgery was no possible, palliative treatments included biliary prosthesis or no treatment. The survival data are confusing. About prognosis, patients with macroscopic IBM show better survival (5 years: 80%) than microscopic IBM (48%) or without bile duct infiltration (57%). Conclusion: IBM should be considered in all patients with a history of CRC presenting dilatation of the bile duct. It is necessary to standardize the definition of this pathology, since the existing terminology may cause confusion and make it difficult to carry out case studies and case series. Surgery is the only curative treatment, but more studies are needed to determine the most appropriate type of liver resection. Anatomic surgery is defended to obtain free margins of the bile duct, while a more economic surgery increases risk of recurrence.
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