Cholangiocarcinoma (Klatskin Tumor) — Embolization or Chemoembolization: treatment in the Best Hospitals in the World
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Department of Interventional Radiology
The Department of Interventional Radiology offers the full range of imaging examinations, as well as innovative image-guided minimally invasive techniques for the treatment of tumors, vascular diseases and internal pathologies (for example, CT, MRI, PET-CT, SPECT). The department's doctors have deep knowledge and colossal experience in the field of interventional radiological methods of treatment, which represent an excellent alternative to open surgical interventions. Despite the high level of technical equipment and the presence of advanced computerized systems, the focus is always on the person with his individual needs. Compliance with current clinical protocols and high professionalism of the department's specialists contribute to the successful clinical practice, as well as the reputability of the department among the best medical facilities of this kind in Germany.
Department of Interventional Radiology and Neuroradiology
The Department of Interventional Radiology and Neuroradiology offers a full range of advanced imaging diagnostics and minimally invasive treatments on both an inpatient and outpatient basis. The department has state-of-the-art medical equipment for imaging tests such as X-ray, computed tomography, magnetic resonance imaging, digital subtraction angiography, and mammography. The medical facility also performs many highly effective interventional therapeutic procedures under image guidance, which in many cases allow patients to avoid traumatic open surgery. For example, the department successfully performs local fibrinolysis, thrombectomy, percutaneous transluminal angioplasty, hemostasis, transarterial chemoembolization, uterine artery embolization, and other procedures. The department's neuroradiologists specialize in brain and spinal cord imaging and the treatment of central nervous system disorders. Interventional neuroradiology focuses on the treatment of carotid artery stenosis, brain aneurysms, arteriovenous malformations, dural fistulas, subdural hematomas, brain tumors, skull base and spinal tumors, and chronic back pain. The department's medical team has extensive clinical experience in their areas of expertise. The specialists are guided by the recommendations of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society for Neuroradiology (DGNR), which helps to achieve the best results.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology is one of the best institutions of its kind in Germany and offers patients the full range of radiological studies and imaging-guided minimally invasive therapy. The department’s scope of tasks also includes imaging diagnostics in children of all age groups, detection and invasive treatment of cerebral vascular pathology (neuroradiology). Patient care is provided both on an inpatient and outpatient basis.
Department of Interventional Radiology
The Department of Interventional Radiology specializes in the full range of minimally invasive image-guided interventions for diagnostic and therapeutic purposes. Diagnostic interventional procedures allow obtaining tissue samples for further laboratory tests. Most minimally invasive interventional procedures are performed for the treatment of vascular obstruction or stenosis, as well as for tumor destruction. The surgeon inserts special catheters and/or probes through small skin punctures. All surgical procedures are performed under image guidance – X-ray, digital subtraction angiography, ultrasound, CT, MRI. The specialist can clearly see all the anatomical structures and a pathological focus, thanks to which he accurately controls the delivery of the catheter to the required site and all subsequent manipulations. It is worth noting that the department was awarded the quality certificate of the German Society for Interventional Radiology (DeGIR) in 2018, which guarantees effective treatment in accordance with modern medical standards. The department's doctors have the necessary skills and qualifications, which allow them to select the best treatment option for each patient and ensure its successful conduction.
Department of Interventional Neuroradiology
The Department of Interventional Neuroradiology offers the full range of services in the areas of its specialization. The medical facility provides imaging diagnostics and low-traumatic image-guided interventional treatment of nervous system diseases. The department's specialists have rich experience and exceptional professional skills in the field of interventional procedures for acute and chronic vascular diseases, such as ischemic strokes, brain hemorrhages, cerebral artery stenosis, brain aneurysms, and vascular malformations. The department's neuroradiologists cooperate closely with neurologists and neurosurgeons so that each patient receives an optimal treatment regimen based on the expert opinions of the specialists. The department's medical team has state-of-the-art computed tomography (CT), magnetic resonance imaging (MRI), and MR angiography systems that are actively used for diagnosing patients and therapeutic procedures. Medical care is provided in compliance with current clinical protocols. The department also offers many outpatient medical services, which is an advantage for many patients.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of medical services in these fields. In order to ensure the most accurate and reliable diagnostics, the department has state-of-the-art systems for CT, MRI, PET, ultrasound and X-ray examinations, as well as PET-CT and SPECT-CT hybrid examinations. The department specializes in interventional radiology, namely, imaging-guided therapy. It performs all vascular (for example, vascular recanalization) and non-vascular imaging-guided interventions (for example, tumor ablation). The department is one of the largest and leading medical facilities of this kind in Europe.
Department of Interventional Radiology
The Department of Interventional Radiology offers a full range of modern imaging tests and image-guided therapeutic procedures. The department performs imaging examinations for patients from all departments of the University Hospital Oldenburg: X-ray, computed tomography, magnetic resonance imaging, sonography, mammography, and angiography; diagnostic examinations are performed on an outpatient basis. To ensure accurate diagnosis and effective treatment, the department has state-of-the-art medical equipment, including a 64-slice spiral CT scanner, two high-performance 1.5 Tesla MRI scanners, advanced equipment for digital subtraction angiography, pulsed fluoroscopy, and many other devices. The department's team of physicians also specializes in image-guided therapeutic interventional procedures – the treatment of vascular stenoses and occlusions, malignant tumors, and chronic back pain. Therapeutic manipulations are often performed on an outpatient basis. The department adheres strictly to radiation safety standards, so patients can expect highly effective and safe treatment.
Department of Adult and Pediatric Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Interventional Radiology, Neuroradiology specializes in modern imaging examinations and minimally traumatic image-guided interventional procedures. Of particular interest to the department's experienced medical team is individualized minimally invasive therapy for cancer and the treatment of pain syndromes and vascular pathologies. The medical facility has state-of-the-art equipment for X-ray scanning, angiography, ultrasound scanning, CT, MRI, and PET/MRI. The diagnostic devices are adapted for children, including newborns. During examinations and treatment, the department's specialists strictly meet radiation protection standards. As for treatment, special attention in clinical practice is paid to interventional procedures for vascular diseases and malignant tumors. These procedures are performed using catheter-based techniques under CT, MRI, or angiography guidance. Despite the low trauma rate of interventional manipulations, their effectiveness is comparable to full-fledged surgery. The medical facility cooperates closely with other departments at the hospital, thus providing comprehensive medical care at the highest level of university medicine. The department's successful clinical practice has been recognized by prestigious quality certificates, including the ClarZert certificate and certificates from the German Cancer Society (DKG) and the German Radiological Society (DRG).
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology provides the full range of services in these fields and specializes in conducting radiologic examinations, high-intensity focused ultrasound (HIFU) therapy, vascular, oncological, orthopedic and urologic interventions. The department includes specialized Sections for Gynecologic, Pediatric and Orthopedic Radiology.
Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology and Neuroradiology
The Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology and Neuroradiology offers the full range of modern radiological examinations and minimally invasive imaging-guided treatment of various diseases. Most often, radiologists have to deal with the diagnostics and therapy of tumors, inflammatory processes, injuries, pathologies of the heart and vascular diseases. The combination of advanced medical technologies and high professionalism of the doctors working in the department are the key to the successful treatment results.
Department of Adult and Pediatric Interventional Radiology
The Department of Adult and Pediatric Interventional Radiology provides the full range of medical services in the area of its specialization. The department offers modern diagnostic rooms with advanced equipment for imaging examinations for patients with suspected cancer, diseases of the cardiovascular system, thorax, abdominal organs, musculoskeletal system, and breast diseases. The department's diagnostic systems are adapted for examining children of different age groups. The medical facility also offers many therapeutic services, the most popular of which include MRI-guided treatment of uterine fibroids with high-intensity focused ultrasound (HIFU) and uterine artery embolization, prostate adenoma treatment with prostate artery embolization, tumor treatment with brachytherapy, percutaneous radiofrequency ablation, percutaneous microwave ablation, and transarterial chemoembolization. The doctors working at the medical facility also have rich experience in the interventional treatment of vascular pathologies and arteriovenous malformations. The department has an excellent reputation and regularly diagnoses and treats patients not only from Germany but also from other countries in the world.
Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology, Neuroradiology offers the full range of services in these medical fields. Here patients can undergo all modern imaging diagnostic studies and therapeutic procedures, the quality of which corresponds to high international standards. The department also specializes in conducting radiological studies in children and adolescents. The cutting-edge technical equipment and the rich clinical experience of doctors contribute to the successful work of the department.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of modern diagnostic and therapeutic procedures in this field. For this purpose, it has advanced medical equipment: magnetic resonance imaging (MRI), multispiral computed tomography (CT), duplex sonography and digital X-ray, fluoroscopy, etc. In the field of interventional radiology, the focus is on the treatment of vascular diseases, for example, the doctors of the department conduct special measures for dilating the vessels in peripheral arterial occlusive disease and closing the vessels in complicated bleedings. Also, the range of services in this field is complemented by the installation of drainage and port systems, punctures, and special percutaneous methods for tumor treatment.
Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology
The Department of Adult and Pediatric Diagnostic Radiology, Interventional Radiology offers the full range of services in these fields. It conducts all types of modern imaging studies: sonography, digital X-ray, angiography, multilayer computed tomography and conventional MRI, positron emission tomography (PET/CT), etc. The department also specializes in minimally invasive treatment of various tumors, vascular pathology (obstruction and vascular stenosis). The Section of Experimental Radiology is engaged in active research to optimize existing methods and develop new ones.
Department of Adult and Pediatric Diagnostic, Interventional Radiology
The Department of Adult and Pediatric Diagnostic, Interventional Radiology offers the full range of services in these medical fields. It conducts all modern radiological examinations and imaging-guided minimally invasive interventions for the treatment of various benign and malignant diseases. A feature of the department is imaging diagnostics in children and adolescents. There are specially adapted devices with minimal irradiation for this purpose.
Department of Interventional Radiology
The Department of Interventional Radiology provides the full range of medical services in the area of its specialization. The team of the department's doctors specializes in diagnostic and therapeutic image-guided interventional procedures. The doctors have at their disposal the most advanced imaging devices, including X-ray systems, ultrasound devices, equipment for computed tomography and magnetic resonance imaging. In most cases, the department's specialists perform interventions on the vessels, and therefore doctors from the Department of Vascular Surgery are often involved in the therapeutic process. The use of state-of-the-art equipment allows the patients to get rid of pathological changes in the vessels of any part of the body, excluding open invasive surgery with its high risks. The department's medical staff has excellent qualifications and vast clinical experience, so patients confidently trust their health to real professionals.
Cholangiocarcinoma is an aggressive malignant tumor with a poor prognosis. The treatment for this condition requires complex surgical interventions and high-tech procedures, which are successfully used in developed countries. German doctors use chemoembolization, radioembolization, ablation, targeted therapy, and other methods that significantly increase the survival rate of patients even with unresectable tumors.
Content
- What is cholangiocarcinoma?
- Cancer surgery
- Radical surgery
- Palliative operations and procedures
- Radiation therapy
- Systemic drug therapy
- Endovascular procedures
- Radiofrequency ablation
- Where can I undergo treatment?
What is cholangiocarcinoma?
Cholangiocarcinoma (also known as bile duct cancer or cholangiocellular cancer) is a group of malignant tumors that develop from the epithelium of the bile ducts. These tumors can be intrahepatic or extrahepatic.
Intrahepatic tumors are relatively rare, accounting for up to 8% of cases. The remaining 92% of cases are neoplasms that appear outside the liver. In turn, these extrahepatic tumors are also divided into two main groups, each occurring with similar frequency:
- Distal bile duct cancer
- Porta hepatis cancer (Klatskin tumor)
Cholangiocarcinomas come in different histologic types, but adenocarcinomas account for up to 90% of all cases.
Cancer surgery
Cholangiocarcinoma treatment is carried out using the following two types of surgical interventions:
- Radical (potentially curable)
- Palliative (for the treatment of jaundice and other complications)
Palliative surgery is used more often because bile duct tumors are usually found at an unresectable stage.
Radical surgery
Radical surgery for cholangiocarcinoma is very complex. It is best performed at experienced medical centers.
Radical surgery is performed if cholangiocarcinoma diagnostics show that the tumor can be totally removed. If there are some doubts, the doctor can perform a diagnostic laparoscopy to clarify the cancer spread.
Surgical treatment varies depending on the location of the tumor:
- For Klatskin tumor treatment, doctors perform a liver resection and remove the gallbladder, bile ducts, and lymph nodes. Sometimes parts of the pancreas and small intestine may be removed.
- For distal bile duct cancer, surgical treatment of cholangiocarcinoma is performed with the help of the Whipple procedure (pancreaticoduodenal resection). Part of the pancreas, duodenum, gallbladder, lymph nodes, and sometimes also part of the jejunum and stomach are removed.
- For intrahepatic bile duct cancer, a liver resection (partial hepatectomy) is performed.
It happens that the tumor can be completely removed, but it is impossible to leave a sufficient amount of liver tissue for the recovery of the organ and the performance of its functions. In this case, the only option for radical treatment is liver transplant surgery. However, this surgery is rarely performed for cholangiocarcinoma due to a lack of available donors. If the waiting period is long, chemoradiotherapy may be used to control the tumor.
Palliative operations and procedures
Most patients have tumors that are unresectable at the time of their detection. They undergo palliative operations and procedures. These interventions not only prevent complications and relieve symptoms but also create conditions for subsequent tumor control with systemic therapy and local procedures.
The most frequent complication of cholangiocarcinoma is biliary obstruction with the development of mechanical jaundice. The following procedures are used to eliminate or prevent this complication:
- Biliary bypass surgery is an operation to form a bypass for bile flow. In developed countries, it can be performed using laparoscopic techniques.
- Endoscopic bougienage and stent implantation assume bile duct dilatation and the placement of a tube inside that keeps the lumen open. This is not surgery, but a minimally invasive procedure that is performed with instruments inserted through the oral cavity.
Bypass surgery is a more reliable treatment option, so it is used more often. Stent implantation is used when life expectancy is low, there are contraindications to bypass surgery, or there is a refusal of this operation.
Radiation therapy
Cholangiocarcinoma is resistant to radiation, so radiation therapy is rarely used in the treatment of this tumor. In rare cases, one of the following two types of radiation therapy can be used:
- External beam radiation therapy
- Endobiliary brachytherapy
External beam radiation therapy is performed in Germany with modern methods using 3D CRT, IMRT, and SBRT techniques, which significantly reduce the course of irradiation.
External beam radiation therapy is usually not used after surgery because it does not significantly affect the risk of recurrence or survival. The benefit of irradiation before surgery has not been proven. Therefore, the method is mainly used to control unresectable tumors and relieve symptoms in the advanced stages of the disease.
Endobiliary (intraductal) brachytherapy is used as a palliative procedure. It is an interventional radiology method. Doctors insert a thin radioactive wire inside the bile ducts to use radiation to destroy the area of the tumor that is blocking the flow of bile.
Systemic drug therapy
The following methods of systemic therapy can be used for cholangiocarcinoma:
- Chemotherapy is the main method used before surgery, after surgery, and as part of chemoradiation therapy in inoperable patients
- Targeted therapy (FGFR2 and IDH1 inhibitors) is used in developed countries (in the presence of appropriate mutations in cancer cells)
Unfortunately, most patients are not candidates for targeted therapy, and systemic chemotherapy has low efficacy.
Endovascular procedures
Since systemic chemotherapy is often ineffective for cholangiocarcinoma, doctors aim to deliver drugs directly to the tumor through the blood supplying vessels rather than into the systemic bloodstream.
Regional chemotherapy options include:
- Continuous infusion of chemotherapy drugs through the hepatic artery using a surgically implanted device
- Transarterial chemoembolization (TACE) involves blocking the blood vessels with substances containing chemotherapy drugs
The TACE procedure is more effective because it involves not only delivering drugs to the tumor but also depriving it of blood supply. Emboli that enter the blood vessels block the arteries supplying the tumor, causing a significant portion of the tumor to die.
Chemoembolization for Klatskin tumor in Germany can be performed using various techniques. The most common are oily chemoembolization of the liver, when lipiodol with dissolved chemotherapy drugs is injected into the arteries, and embolizing drug-saturated microspheres. The second type of procedure is considered more effective. Microspheres, unlike lipiodol, irreversibly disrupt the blood flow within the tumor. In addition, they provide a longer lasting drug effect on cancer cells.
Chemoembolization works well even for large and multiple tumors. It increases the life expectancy of patients. Moreover, the treatment is minimally invasive and rarely causes severe complications. All procedures are performed from inside the blood vessels through an incision in the groin area under X-ray guidance.
Another option for embolization for cholangiocarcinoma is radioembolization. This is the injection of Yttrium-90 microspheres into the blood vessels supplying the tumor. The indication for this procedure is an unresectable tumor with an expected life expectancy of more than 3 months. The efficacy of the procedure was proven in a systematic review by Al-Adra et al. (1) Radioembolization provided a partial response (tumor reduction by more than a third) in 28% of patients and disease stabilization in 54%, with a median survival of 15.5 months.
Radiofrequency ablation
Radiofrequency ablation can provide good results in inoperable patients with intrahepatic cholangiocarcinoma. This is a minimally invasive treatment method. A probe is inserted into the tumor and heated. Due to the high temperature, the neoplasm is destroyed.
Research confirms the effectiveness of this approach. For example, Yin Fu et al. treated 17 patients, 7 of whom were newly diagnosed and 10 had recurrent cholangiocarcinoma. After the completion of ablation, the physicians obtained a three-year survival rate of 43.3% and a five-year survival rate of 28.9%. The best results were achieved in patients without lymph node metastases, with fewer tumors in the liver, and with less aggressive histologic tumor types. (2)
Where can I undergo treatment?
You can undergo your diagnostics and treatment in Germany. The leading clinics in the country are presented on the Booking Health website.
You are welcome to use our service to choose the best hospitals for cholangiocarcinoma treatment and find out the cost of medical services for treatment abroad. When you make your treatment appointment through Booking Health, the prices will be lower for you due to the lack of additional coefficients for foreign patients. Our specialists will help you select a hospital and arrange your trip.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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