Mayo clinic protocol |
External beam radiation therapy (45 Gy in 30 fractions, 1.5 Gy twice daily) |
Brachytherapy (20 Gy at 1 cm in approximately 20‐25 h) – administered 2 wks following completion of external beam radiation therapy |
Capecitabine – administered until the time of transplantation, held during perioperative period for staging |
Abdominal exploration for staging – as time nears for deceased donor transplantation or day prior to living donor transplantation |
Liver transplantation |
Inclusion criteria |
Diagnosis of pCCA (transcatheter biopsy or brush cytology, CA 19‐9 > 100 mg/mL and/or a mass on cross‐sectional imaging with a malignant appearing stricture on cholangiography) |
Unresectable tumour above cystic duct (pancreatoduodenectomy for microscopic involvement of CBD, resectable pCCA arising in PSC) |
Radial tumour diameter 3 cm |
Absence of intrahepatic and extrahepatic metastases |
Candidate for liver transplantation |
Exclusion criteria |
Intrahepatic cholangiocarcinoma |
Uncontrolled infection |
Prior radiation or chemotherapy |
Prior biliary resection or attempt resection |
Intrahepatic metastases |
Evidence of extrahepatic disease |
History of other malignancy within 5 years |
Transperitoneal biopsy (including percutaneous and EUS‐guided FNA) |