Journal of Liver: Disease & TransplantationISSN: 2325-9612

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Case Report, J Liver Dis Transplant Vol: 2 Issue: 2

Complete Resolution of a Malignant Biliary Stricture Using Combined Neoadjuvant Chemoradiation and Brachytherapy Boost Prior to Orthotopic Liver Transplantation

Jason J Schwartz1*, Heather F Thiesset2, William R Hutson3, Lisa Hazard4, Jonathan Tward5 and James Carlisle6
1Department of Surgery, Division of Surgical Transplantation, University of Texas, Southwestern, Dallas, TX, USA
2Department of Surgery, Section of Transplantation, University of Utah, School of Medicine, Salt Lake City, UT, USA
3Division of Gastroenterology & Hepatology, University of Maryland, School of Medicine, Baltimore, MD, USA
4Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
5Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, UT, USA
6Utah Imaging Associates, Salt Lake City, UT, USA
Corresponding author : Jason J Schwartz, M.D.
Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern, 5323 Harry Hines Blvd. Dallas, Texas 75390-9031, USA
Tel: 214-645-7881; Fax: 214-645-7714
E-mail: [email protected]
Received: June 13, 2013 Accepted: November 20, 2013 Published: November 25, 2013
Citation: Schwartz JJ, Thiesset HF, Hutson WR, Hazard L, Tward J, et al., (2013) Complete Resolution of a Malignant Biliary Stricture using Combined Neoadjuvant Chemoradiation and Brachytherapy Boost Prior to Orthotopic Liver Transplantation. J Liver: Dis Transplant 2:2. doi:10.4172/2325-9612.1000114

Abstract

Complete Resolution of a Malignant Biliary Stricture Using Combined Neoadjuvant Chemoradiation and Brachytherapy Boost Prior to Orthotopic Liver Transplantation

To limit recurrence and intra-operative tumor dissemination at the time of transplant, there is increasing evidence that neoadjuvant chemoradiation and brachytherapy boost helps facilitate successful liver transplantation in patients with earlystage unresectable hilar cholangiocarcinoma. In published reports, a complete response to neoadjuvant therapy frequently limits the ability to detect residual disease in the hepatectomy specimen, thereby inviting criticism over whether published results are due to the neoadjuvant protocol per se, or selection of patients with earlystage or pre-malignant disease. In this report, a 41 year old male with a malignant biliary stricture received 45 Gy external beam radiation in conjunction with 5-fluoruracil as a prelude to transplant. This was followed by a transluminal boost of radiation (2000 cGy) using an Iridium-192 brachytherapy wire inserted through percutaneously-placed biliary catheters. Using this approach, we document the complete resolution of the patient’s malignant stricture, thereby objectively quantifying tumor response prior to orthotopic liver transplantation.

Keywords: Neoadjuvant therapy; Cholangiocarcinoma; Biliary stricture; Liver transplantation

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