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Liver Transplantation for Hilar Cholangiocarcinoma in Association With Neoadjuvant Radio- and Chemo-therapy

This study is currently recruiting participants.
Verified July 2012 by Azienda Ospedaliera di Padova
Sponsor:
Information provided by (Responsible Party):
Prof. Umberto Cillo, Azienda Ospedaliera di Padova
ClinicalTrials.gov Identifier:
NCT01549795
First received: March 7, 2012
Last updated: July 17, 2012
Last verified: July 2012
History of Changes

March 7, 2012
July 17, 2012
January 2012
July 2013   (final data collection date for primary outcome measure)
  • Percentage of patients free of disease at 24 months post-transplant [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  • Time to recurrence after liver transplant [ Time Frame: 24 months ] [ Designated as safety issue: No ]
Same as current
Complete list of historical versions of study NCT01549795 on ClinicalTrials.gov Archive Site
  • Progression disease free survival [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  • Overall 2 years survival after liver transplantation [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  • Complication rate due to radiotherapy (Hepatic artery thrombosis and Portal vein thrombosis) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Liver Transplantation for Hilar Cholangiocarcinoma in Association With Neoadjuvant Radio- and Chemo-therapy
Trapianto di Fegato Per Colangiocarcinoma (CCA) Ilare in Associazione a Radio e Chemioterapia Neoadiuvante

Single-arm pilot clinical trial. Patients with non operable CC associated with PSC will be subjected to liver transplantation after a neoadjuvant multimodal therapy protocol.

Cholangiocarcinoma (CC) accounts for 3% of all gastrointestinal cancers; it is more frequent in patients with primary sclerosing cholangitis (PSC), who carry an 8%-12% risk of developing this type of neoplasm. Only a minority of patients are suitable for resection partly because of the anatomic position of the tumor (which often arises from the bile duct bifurcation) and partly because of the frequently coexisting liver disease. In fact, CC is currently considered a major contraindication to liver transplantation (OLT) at the majority of centers, given a 5-year survival rate of 0%-35%.

New strategies have been developed for the treatment of this kind of cancer arising in PSC. The Nebraska University group showed a 1 and 3 years survival of 55 and 45 % combining a neoadjuvant intra bile duct barchytherapy and 5-FU based chemotherapy with liver transplantation. University of Pittsburg proposed also a neoadjuvant protocol prior to liver transplantation based on systemic chemotherapy and external radiotherapy reporting a 53% 5 years survival. More convincing results come from the Mayo Clinic. An accurate selection of patients and a proper neoadjuvant multimodal therapy (chemotherapy, external radiotherapy and intraluminal bile duct brachytherapy) lead to a 80% 5 years survival after liver transplantation.
Not Provided
Interventional
Not Provided
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Hilar Cholangiocarcinoma
  • Primary Sclerosing Cholangitis
  • Procedure: Liver transplantation
    Liver transplantation using classic technique and avoiding proximal ilum dissection. The donor hepatic artery will be anastomosed to a jump graft connected to the Aorta. In case of positive margin of the bile duct at a frozen section analysis the liver transplant will be performed after an adjunctive pancreatodudodenctomy
  • Radiation: 45 Gy external radiations
    45 Gy in 30 fractions, 1,5 Gy twice a day) and 5-FU iv infusion- 3 week treatment
  • Radiation: Endoluminal bile duct Brachytherapy
    Brachytherapy (20 Gy a 1 cm in 20-25h) - administered 2 weeks after radiotherapy completion
  • Drug: Capecitabine
    Capecitabine - administered till liver transplantation
  • Procedure: Pre liver transplantation laparoscopic hand assisted staging
    Pre liver transplantation laparoscopic hand assisted staging for sampling hepatic artery lymph nodes and assessing peritoneal disease.
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
33
Not Provided
July 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Older than 18 years
  • Male or female
  • Diagnosis of Cholangiocarcinoma using:
  • PTBD biopsy or Brushing cytology
  • Ca 19-9>100mg/ml and/or liver mass at CT or MRI with malignant stenosis apperance at Cholangiography,
  • Non resectable tumour araising above the cystic duct
  • Absence of intra and extra hepatic metastasis
  • ECOG score(Eastern Cooperative Oncology Group) 0
  • ASA score (American Society of Anesthesiologists) ≤ 3
  • Ability to understand and willingness to sign the written informed consent form (ICF)

Exclusion Criteria:

  • Intrahepatic Cholangiocarcinoma
  • Non controlled infection
  • Previous radio or chemotherapy
  • Previsous bile duct resection or attempt to resection
  • Intra and/or extrahepatic metastasis
  • Preivious malignant neoplasm (within 5 years)
  • Execution of trans peritoneal biopsy
  • Tumour diameter more than 3 cm
Both
18 Years to 65 Years
No
Contact: Umberto Cillo, MD +390498218547 cillo@unipd.it
Contact: Enrico Gringeri, MD +390498218547 enrico.gringeri@unipd.it
Italy
 
NCT01549795
2372P
Yes
Prof. Umberto Cillo, Azienda Ospedaliera di Padova
Azienda Ospedaliera di Padova
Not Provided
Study Chair: Umberto Cillo, MD Azienda Ospedaliera di Padova
Principal Investigator: Enrico Gringeri, MD Azienda Ospedaliera di Padova
Azienda Ospedaliera di Padova
July 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP