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Treatment Options

Localized and potentially resectable disease

  • Primary surgery as described above
  • There is no  proven role for adjuvant chemotherapy or radiotherapy for completely resected early-stage biliary cancer
  • Patients with microscopic residual disease (R1 resection) would benefit from review in multidisciplinary conference to determine suitability for adjuvant-intent chemotherapy or chemoradiation

Unresectable lesions:

  • Referral for palliative chemotherapy
  • Referal for radiotherapy if local symptoms (pain, bleeding, obstruction are present)
Palliative Chemotherapy for unresectable or metastatic disease
  • Patients should be referred for consideration of palliative chemotherapy, clinical trials, and/or supportive care
  • Palliative radiotherapy may be a consideration for local symptoms (e.g. alleviation of pain bleeding or jaundice) 
  • Palliative chemotherapy can extend survival in appropriately selected patients and may help improve symptoms and quality of life 
  • Currently approved chemotherapeutic agents for unresectable biliary and gall bladder cancer include: gemcitablne, cisplatin, and 5-fluorouracil (5-FU)
    • The most commonly used regimens are:
      • gemcitabine and cisplatin (GIAVPG
      • 5-FU and cisplatin (GIFUC)
      • single-agent 5-FU (GIAVFL
    • The choice and sequence of chemotherapy is determined by disease-related factors, patient factors and patient preferences as assessed by the medical oncologist
  • Consider treatment on a clinical trial, if available
  • Symptom management, best supportive care, and involvement of palliative care services as indicated by patient’s clinical status

SOURCE: Treatment Options ( )
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