- 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
- Referral for palliative chemotherapy
- Referral 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: gemcitabine, 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
