Extrahepatic Cholangiocarcinoma: Experience from Misurata Cancer Center, Libya (2012-2014)

Abstract

Twenty five patientswere registered in Misurata Cancer Center between January, 2012
and June, 2014 to haveextrahepaticcholangiocarcinoma (ECC). The median age was 52
years (range from 32-78 years). Eighteen patients(72%) were males and7 patients (28%)
were females.Fourteen patients had ECOG performance status score 0 or 1 and 11 patients
had score 2 or 3. All the patients presented with obstructive jaundice. Fifteen patients
(60%) had perihilar (Klatskin) tumors, and the remaining (40%) had distal bile duct tumors.
Twelve patients had cytological or histological confirmatory diagnosis. Six patients
underwent preoperative laparoscopic evaluation before surgery, 2 of them proved to have
disseminated peritoneal deposits and rendered inoperable.Atotal 21 patient were rendered to
have unresectable tumor due to either extensive liver infiltration (6 patients), ornon regional
LN metastasis and/or distant metastasis (15patients).Four patients underwent Whipple
surgery, one patient died due to sepsis and hemorrhage,and 3 patients remained alive till
time of analysis, one of them received 6 cycles of adjuvant chemotherapy (gemcitabine and
cisplatin) due to lymph node metastasis. Of the remaining 21 patients, 18 patients
underwent biliary stenting guided by ERCP (16 patients) or PTC (2 patients). The bilirubin
was normalized in 15 patients. A total of 13 patients received palliativechemotherapy,
gemcitabine/cisplatin regimen. The total number of chemotherapy cycles was 67 cycles
(range from 2-9 cycles per patient). Eight of 13 patients (61.5%) who received
chemotherapy had any ≥ grade 3 (severe) toxicity. The most common severe chemotherapy
toxicities were neutropenia (6 patients 46%), anemia (4 patients 31%), thrombocytopenia (3
patients 23%), neutropenic fever (2 patients 15%), nausea and vomiting (3 patients 23%),
and lethargy( 2 patients 15%).Complete response (CR) was achieved in 1 patient (7.6%),
partial response (PR) in 3 patients (23%) and stable disease (SD) in 5 patients (38.4%)
while 4 patients (31%) had disease progression (DP) during therapy.The median
progression free survival (PFS) was 4.4 months. The median overall survival (OS) was 8.4
months.