Hepatobiliary Cancers Clinical Practice Guidelines in OncologyNCCN Categories of Evidence and ConsensusCategory 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus.Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).Category 3: The recommendation is based on any level of evidence but reflects major disagreement.All recommendations are category 2A unless otherwise noted.Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.OverviewHepatobiliary cancers are highly lethal. In 2008, approximately 21,370 persons in the United States were estimated to be diagnosed with liver or intrahepatic bile duct cancer and 9520 with gallbladder cancer or other biliary tract cancer. Furthermore, approximately 18,410 deaths from liver or intrahepatic bile duct cancer and 3340 deaths from gallbladder cancer or other biliary tract cancer were estimated to occur.1The types of hepatobiliary cancers covered in these guidelines include hepatocellular carcinoma (HCC), gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. By definition, these guidelines cannot incorporate all possible clinical variations and are not intended to replace good clinical judgment or individualization of treatments. Although not explicitly stated at every decision point of the guidelines, patient participation in prospective clinical trials is the preferred option for treatment of hepatobiliary cancers.HCCRisk Factors and...

If the inline PDF is not rendering correctly, you can download the PDF file here.


  • 1

    JemalASiegelRWardE. Cancer statistics, 2008. CA Cancer J Clin2008;58:7196.

  • 2

    FattovichGStroffoliniTZagniIDonatoF. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology2004;127(5 Suppl 1):S3550.

  • 3

    BoschFXRibesJBorrasJ. Epidemiology of primary liver cancer. Semin Liver Dis1999;19:271285.

  • 4

    BruixJShermanM. Management of hepatocellular carcinoma. Hepatology2005;42:12081236.

  • 5

    Di BisceglieAMLyraACSchwartzM. Hepatitis C-related hepatocellular carcinoma in the United States: influence of ethnic status. Am J Gastroenterol2003;98:20602063.

  • 6

    MarchesiniGBugianesiEForlaniG. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology2003;37:917923.

  • 7

    TakamatsuSNoguchiNKudohA. Influence of risk factors for metabolic syndrome and non-alcoholic fatty liver disease on the progression and prognosis of hepatocellular carcinoma. Hepatogastroenterology2008;55:609614.

  • 8

    BartlettDLDi BisceglieAMDawsonLA. Cancer of the liver. In: DeVitaVTLawrenceTSRosenbergSA eds. Cancer: Principles and Practice of Oncology. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2008:11291156.

  • 9

    LokASMcMahonBJ. Chronic hepatitis B. Hepatology2007;45:507539.

  • 10

    VolkMLMarreroJA. Early detection of liver cancer: diagnosis and management. Curr Gastroenterol Rep2008;10:6066.

  • 11

    LokASSeeffLBMorganTR. Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology2009;136:138148.

  • 12

    YeomanADAl-ChalabiTKaraniJB. Evaluation of risk factors in the development of hepatocellular carcinoma in autoimmune hepatitis: implications for follow-up and screening. Hepatology2008;48:863870.

  • 13

    BeatonMDAdamsPC. Prognostic factors and survival in patients with hereditary hemochromatosis and cirrhosis. Can J Gastroenterol2006;20:257260.

  • 14

    IchikawaTYanagiKMotoyoshiY. Two cases of nonalcoholic steatohepatitis with development of hepatocellular carcinoma without cirrhosis. J Gastroenterol Hepatol2006;21:18651866.

  • 15

    GuzmanGBruntEMPetrovicLM. Does nonalcoholic fatty liver disease predispose patients to hepatocellular carcinoma in the absence of cirrhosis?Arch Pathol Lab Med2008;132:17611766.

  • 16

    Department of Health and Human Services Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. Available at: www.cdc.gov/nchs/data/nhanes/databriefs/viralhep.pdf. Accessed February 19 2009.

  • 17

    AlterMJ. The epidemiology of acute and chronic hepatitis C. Clin Liver Dis1997;1:559568.

  • 18

    RyderSDIrvingWLJonesDA. Progression of hepatic fibrosis in patients with hepatitis C: a prospective repeat liver biopsy study. Gut2004;53:451455.

  • 19

    LavanchyD. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol2005;34Suppl 1:S13.

  • 20

    GoldsteinSTZhouFHadlerSC. A mathematical model to estimate global hepatitis B disease burden and vaccination impact. Int J Epidemiol2005;34:13291339.

  • 21

    BeasleyRPHwangLYLinCCChienCS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet1981;2:11291133.

  • 22

    YounossiZM. Review article: current management of nonalcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther2008;28:212.

  • 23

    SanyalAJBanasCSargeantC. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology2006;43:682689.

  • 24

    YatsujiSHashimotoETobariM. Clinical features and outcomes of cirrhosis due to non-alcoholic steatohepatitis compared with cirrhosis caused by chronic hepatitis C. J Gastroenterol Hepatol2008;24:248254.

  • 25

    AsareGABronzMNaidooVKewMC. Synergistic interaction between excess hepatic iron and alcohol ingestion in hepatic mutagenesis. Toxicology2008;254:1118.

  • 26

    SingalAKAnandBS. Mechanisms of synergy between alcohol and hepatitis C virus. J Clin Gastroenterol2007;41:761772.

  • 27

    ZhangBHYangBHTangZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol2004;130:417422.

  • 28

    ChangPEOngWCLuiHFTanCK. Is the prognosis of young patients with hepatocellular carcinoma poorer than the prognosis of older patients? A comparative analysis of clinical characteristics, prognostic features, and survival outcome. J Gastroenterol2008;43:881888.

  • 29

    El-SeragHBMarreroJARudolphLReddyKR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology2008;134:17521763.

  • 30

    ZhangBYangB. Combined alpha fetoprotein testing and ultrasonography as a screening test for primary liver cancer. J Med Screen1999;6:108110.

  • 31

    BreedisCYoungG. The blood supply of neoplasms in the liver. Am J Pathol1954;30:969977.

  • 32

    BruixJShermanMLlovetJM. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol2001;35:421430.

  • 33

    MillerGSchwartzLHD’AngelicaM. The use of imaging in the diagnosis and staging of hepatobiliary malignancies. Surg Oncol Clin N Am2007;16:343368.

  • 34

    MarreroJAHussainHKNghiemHV. Improving the prediction of hepatocellular carcinoma in cirrhotic patients with an arterially-enhancing liver mass. Liver Transpl2005;11:281289.

  • 35

    FornerAVilanaRAyusoC. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology2008;47:97104.

  • 36

    TorzilliGMinagawaMTakayamaT. Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy. Hepatology1999;30:889893.

  • 37

    LevyIGreigPDGallingerS. Resection of hepatocellular carcinoma without preoperative tumor biopsy. Ann Surg2001;234:206209.

  • 38

    DurazoFABlattLMCoreyWG. Des-gamma-carboxyprothrombin, alpha-fetoprotein and AFP-L3 in patients with chronic hepatitis, cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol2008;23:15411548.

  • 39

    DebruyneENDelangheJR. Diagnosing and monitoring hepatocellular carcinoma with alpha-fetoprotein: new aspects and applications. Clin Chim Acta2008;395:1926.

  • 40

    KatyalSOliverJHIIIPetersonMS. Extrahepatic metastases of hepatocellular carcinoma. Radiology2000;216:698703.

  • 41

    NatsuizakaMOmuraTAkaikeT. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol2005;20:17811787.

  • 42

    CooperGSBellamyPDawsonNV. A prognostic model for patients with end-stage liver disease. Gastroenterology1997;113:12781288.

  • 43

    PughRNMurray-LyonIMDawsonJL. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg1973;60:646649.

  • 44

    CholongitasEPapatheodoridisGVVangeliM. Systematic review: the model for end-stage liver disease--should it replace Child-Pugh’s classification for assessing prognosis in cirrhosis?Aliment Pharmacol Ther2005;22:10791089.

  • 45

    BruixJCastellsABoschJ. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology1996;111:10181022.

  • 46

    GroszmannRJWongcharatraweeS. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology2004;39:280282.

  • 47

    BoyerTD. Changing clinical practice with measurements of portal pressure. Hepatology2004;39:283285.

  • 48

    ThalheimerUMelaMPatchDBurroughsAK. Targeting portal pressure measurements: a critical reappraisal. Hepatology2004;39:286290.

  • 49

    MalinchocMKamathPSGordonFD. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology2000;31:864871.

  • 50

    MartinAPBartelsMHaussJFangmannJ. Overview of the MELD score and the UNOS adult liver allocation system. Transplant Proc2007;39:31693174.

  • 51

    EggelH. Uber das primare Carcinoma der Leber. Beitr Pathol Anat Allg Pathol1901;30:506604.

  • 52

    ClavienPAFongYLyerlyHK. Malignant Liver Tumors: Current and Emerging Therapies. 2nd ed. Sudbury: Jones and Barlett; 2003.

  • 53

    YukiKHirohashiSSakamotoM. Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer1990;66:21742179.

  • 54

    DohmenK. Many staging systems for hepatocellular carcinoma: evolution from Child-Pugh, Okuda to SLiDe. J Gastroenterol Hepatol2004;19:12271232.

  • 55

    MarreroJAFontanaRJBarratA. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology2005;41:707716.

  • 56

    KamathPSWiesnerRHMalinchocM. A model to predict survival in patients with end-stage liver disease. Hepatology2001;33:464470.

  • 57

    GreeneFPageDFlemingIFritzA. AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag; 2002.

  • 58

    OkudaKOhtsukiTObataH. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer1985;56:918928.

  • 59

    ChevretSTrinchetJCMathieuD. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. J Hepatol1999;31:133141.

  • 60

    LeungTWTangAMZeeB. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer2002;94:17601769.

  • 61

    KudoMChungHOsakiY. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol2003;38:207215.

  • 62

    The Cancer of the Liver Italian Program (CLIP) investigators. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. Hepatology1998;28:751755.

  • 63

    LlovetJMBruCBruixJ. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis1999;19:329338.

  • 64

    OmagariKHondaSKadokawaY. Preliminary analysis of a newly proposed prognostic scoring system (SLiDe score) for hepatocellular carcinoma. J Gastroenterol Hepatol2004;19:805811.

  • 65

    HuoTILinHCHuangYH. The model for end-stage liver disease-based Japan Integrated Scoring system may have a better predictive ability for patients with hepatocellular carcinoma undergoing locoregional therapy. Cancer2006;107:141148.

  • 66

    LimquiacoJLWongGLWongVW. Evaluation of Model for End Stage Liver Disease (MELD)-based systems as prognostic index for hepatocellular carcinoma. J Gastroenterol Hepatol2008;24:6369.

  • 67

    NanashimaASumidaYAboT. Modified Japan Integrated Staging is currently the best available staging system for hepatocellular carcinoma patients who have undergone hepatectomy. J Gastroenterol2006;41:250256.

  • 68

    WangJHChangchienCSHuTH. The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma—survival analysis of 3892 patients. Eur J Cancer2008;44:10001006.

  • 69

    VautheyJNRiberoDAbdallaEK. Outcomes of liver transplantation in 490 patients with hepatocellular carcinoma: validation of a uniform staging after surgical treatment. J Am Coll Surg2007;204:10161027; discussion 1027–1018.

  • 70

    HuitzilFDCapanuMO’ReillyE. Ranking and improvement of staging systems in advanced hepatocellular carcinoma [abstract]. Presented at the 2008 Gastrointestinal Cancers Symposium; January 25–27, 2008; Orlando, Florida. Abstract 210.

  • 71

    ChoYKChungJWKimJK. Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Cancer2008;112:352361.

  • 72

    ColletteSBonnetainFPaolettiX. Prognosis of advanced hepatocellular carcinoma: comparison of three staging systems in two French clinical trials. Ann Oncol2008;19:11171126.

  • 73

    GuglielmiARuzzenenteAPacheraS. Comparison of seven staging systems in cirrhotic patients with hepatocellular carcinoma in a cohort of patients who underwent radiofrequency ablation with complete response. Am J Gastroenterol2008;103:597604.

  • 74

    ChoCSGonenMShiaJ. A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma. J Am Coll Surg2008;206:281291.

  • 75

    KelleyRKVenookAP. Sorafenib in hepatocellular carcinoma: separating the hype from the hope. J Clin Oncol2008;26:58455848.

  • 76

    PawlikTMPoonRTAbdallaEK. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg2005;140:450457; discussion 457–458.

  • 77

    ChokKSNgKKPoonRT. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg2009;96:8187.

  • 78

    KianmaneshRRegimbeauJMBelghitiJ. Selective approach to major hepatic resection for hepatocellular carcinoma in chronic liver disease. Surg Oncol Clin N Am2003;12:5163.

  • 79

    LlovetJMFusterJBruixJ. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology1999;30:14341440.

  • 80

    PoonRTFanSTLoCM. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg2002;235:373382.

  • 81

    SeoDDLeeHCJangMK. Preoperative portal vein embolization and surgical resection in patients with hepatocellular carcinoma and small future liver remnant volume: comparison with transarterial chemoembolization. Ann Surg Oncol2007;14:35013509.

  • 82

    WeiACTung-Ping PoonR. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg2003;90:3341.

  • 83

    RiberoDCurleySAImamuraH. Selection for resection of hepatocellular carcinoma and surgical strategy: indications for resection, evaluation of liver function, portal vein embolization, and resection. Ann Surg Oncol2008;15:966992.

  • 84

    TsaiTJChauGYLuiWY. Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Surgery2000;127:603608.

  • 85

    AbdallaEKDenysAHasegawaK. Treatment of large and advanced hepatocellular carcinoma. Ann Surg Oncol2008;15:979985.

  • 86

    JonasSBechsteinWOSteinmullerT. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology2001;33:10801086.

  • 87

    VautheyJNLauwersGYEsnaolaNF. Simplified staging for hepatocellular carcinoma. J Clin Oncol2002;20:15271536.

  • 88

    YamakadoKNakatsukaATakakiH. Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology2008;247:260266.

  • 89

    KubotaKMakuuchiMKusakaK. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology1997;26:11761181.

  • 90

    ShoupMGonenMD’AngelicaM. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg2003;7:325330.

  • 91

    FargesOBelghitiJKianmaneshR. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg2003;237:208217.

  • 92

    MazzaferroVRegaliaEDociR. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med1996;334:693699.

  • 93

    MazzaferroVChunYSPoonRT. Liver transplantation for hepatocellular carcinoma. Ann Surg Oncol2008;15:10011007.

  • 94

    United Network for Organ Sharing: Organ Donation and Transplantation. Available at: www.unos.org. Accessed February 19 2009.

  • 95

    LlovetJMBruixJGoresGJ. Surgical resection versus transplantation for early hepatocellular carcinoma: clues for the best strategy. Hepatology2000;31:10191021.

  • 96

    FacciutoMEKoneruBRoccaJP. Surgical treatment of hepatocellular carcinoma beyond Milan criteria. Results of liver resection, salvage transplantation, and primary liver transplantation. Ann Surg Oncol2008;15:13831391.

  • 97

    PoonRT. Optimal initial treatment for early hepatocellular carcinoma in patients with preserved liver function: transplantation or resection?Ann Surg Oncol2007;14:541547.

  • 98

    PoonRTFanSTLoCM. Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation: impact on long-term survival. Ann Surg2007;245:5158.

  • 99

    VolkMLHernandezJCLokASMarreroJA. Modified Charlson comorbidity index for predicting survival after liver transplantation. Liver Transpl2007;13:15151520.

  • 100

    IoannouGNPerkinsJDCarithersRLJr. Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival. Gastroenterology2008;134:13421351.

  • 101

    VolkMLVijanSMarreroJA. A novel model measuring the harm of transplanting hepatocellular carcinoma exceeding Milan criteria. Am J Transplant2008;8:839846.

  • 102

    DuffyJPVardanianABenjaminE. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg2007;246:502509; discussion 509–511.

  • 103

    YaoFYFerrellLBassNM. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology2001;33:13941403.

  • 104

    VolkMMarreroJA. Liver transplantation for hepatocellular carcinoma: who benefits and who is harmed?Gastroenterology2008;134:16121614.

  • 105

    LeeSGHwangSMoonDB. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl2008;14:935945.

  • 106

    YaoFYXiaoLBassNM. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant2007;7:25872596.

  • 107

    LlovetJMDi BisceglieAMBruixJ. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst2008;100:698711.

  • 108

    PompiliMMiranteVGRondinaraG. Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: assessment of efficacy at explant analysis and of safety for tumor recurrence. Liver Transpl2005;11:11171126.

  • 109

    MazzaferroVBattistonCPerroneS. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg2004;240:900909.

  • 110

    RichardHMIIISilberzweigJEMittyHA. Hepatic arterial complications in liver transplant recipients treated with pretransplantation chemoembolization for hepatocellular carcinoma. Radiology2000;214:775779.

  • 111

    KulikLMAtassiBvan HolsbeeckL. Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J Surg Oncol2006;94:572586.

  • 112

    VivarelliMGuglielmiARuzzenenteA. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg2004;240:102107.

  • 113

    LinSMLinCJLinCC. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut2005;54:11511156.

  • 114

    ChenMSLiJQZhengY. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg2006;243:321328.

  • 115

    LivraghiTGoldbergSNLazzaroniS. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology2000;214:761768.

  • 116

    LivraghiTMeloniFDi StasiM. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice?Hepatology2008;47:8289.

  • 117

    LinSMLinCJLinCC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology2004;127:17141723.

  • 118

    BrunelloFVeltriACarucciP. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol2008;43:727735.

  • 119

    ShiinaSTerataniTObiS. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology2005;129:122130.

  • 120

    YanKChenMHYangW. Radiofrequency ablation of hepatocellular carcinoma: long-term outcome and prognostic factors. Eur J Radiol2008;67:336347.

  • 121

    ChoiDLimHKRhimH. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol2007;17:684692.

  • 122

    SalaMLlovetJMVilanaR. Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma. Hepatology2004;40:13521360.

  • 123

    MaluccioMCoveyAMGandhiR. Comparison of survival rates after bland arterial embolization and ablation versus surgical resection for treating solitary hepatocellular carcinoma up to 7 cm. J Vasc Interv Radiol2005;16:955961.

  • 124

    MaluccioMACoveyAMPoratLB. Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol2008;19:862869.

  • 125

    KulikLMCarrBIMulcahyMF. Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology2008;47:7181.

  • 126

    LlovetJMRealMIMontanaX. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet2002;359:17341739.

  • 127

    RamseyDEKernagisLYSoulenMCGeschwindJF. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol2002;13:S211221.

  • 128

    O’NeilBHVenookAP. Hepatocellular carcinoma: the role of the North American GI Steering Committee Hepatobiliary Task Force and the advent of effective drug therapy. Oncologist2007;12:14251432.

  • 129

    LoCMNganHTsoWK. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology2002;35:11641171.

  • 130

    StuartKStokesKJenkinsR. Treatment of hepatocellular carcinoma using doxorubicin/ethiodized oil/gelatin powder chemoembolization. Cancer1993;72:32023209.

  • 131

    LladoLVirgiliJFiguerasJ. A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer2000;88:5057.

  • 132

    DoanPLO’NeilBHMooreDTBernardSA. Predictors of survival in patients with hepatocellular carcinoma treated with transarterial chemoembolization [abstract]. Presented at the 2008 Gastrointestinal Cancers Symposium; January 25–27, 2008; Orlando, Florida. Abstract 204.

  • 133

    MolinariMDixonEKachuraJR. Chemoembolization for unresectable hepatocellular carcinoma?Presented at the 2004 Gastrointestinal Cancers Symposium; January 22–24, 2004; Orlando, Florida. Abstract 167.

  • 134

    IbrahimSMLewandowskiRJSatoKT. Radioembolization for the treatment of unresectable hepatocellular carcinoma: a clinical review. World J Gastroenterol2008;14:16641669.

  • 135

    AtassiBBangashAKBahraniA. Multimodality imaging following 90Y radioembolization: a comprehensive review and pictorial essay. Radiographics2008;28:8199.

  • 136

    HawkinsMADawsonLA. Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer2006;106:16531663.

  • 137

    IkedaMOkusakaTUenoH. Hepatic arterial infusion chemotherapy with epirubicin in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis. Oncology2007;72:188193.

  • 138

    ThomasMBO’BeirneJPFuruseJ. Systemic therapy for hepatocellular carcinoma: cytotoxic chemotherapy, targeted therapy and immunotherapy. Ann Surg Oncol2008;15:10081014.

  • 139

    YeoWMokTSZeeB. A randomized phase III study of doxorubicin versus cisplatin/interferon alpha-2b/doxorubicin/fluorouracil (PIAF) combination chemotherapy for unresectable hepatocellular carcinoma. J Natl Cancer Inst2005;97:15321538.

  • 140

    LlovetJMRicciSMazzaferroV. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med2008;359:378390.

  • 141

    ChengAKangYKChenCL. Randomized phase III trial of sorafenib versus placebo in Asian patients with advanced hepatocellular carcinoma [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 4509.

  • 142

    Abou-AlfaGKSchwartzLRicciS. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol2006;24:42934300.

  • 143

    RaoulJLSantoroABeaugrandM. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to ECOG performance status: a subanalysis from the SHARP trial [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 4587.

  • 144

    CraxiAPortaCSangiovanniA. Efficacy and safety of sorafenib in patients with alcohol-related hepatocellular carcinoma: a sub-analysis from the SHARP trial [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 15591.

  • 145

    BolondiLCasparyJBennounaB. Clinical benefit of sorafenib in hepatitis C patients with hepatocellular carcinoma: subgroup analysis of the SHARP trial [abstract]. Presented at the 2008 Gastrointestinal Cancers Symposium; January 25–27, 2008; Orlando, Florida. Abstract 129.

  • 146

    Abou-AlfaGAmadoriDSantoroA. Is sorafenib safe and effective in patients with hepatocellular carcinoma and Child-Pugh B cirrhosis? [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 4518.

  • 147

    MillerAAMurryDJOwzarK. Pharmacokinetic and phase I study of sorafenib for solid tumors and hematologic malignancies in patients with hepatic or renal dysfunction: CALGB 60301 [abstract]. J Clin Oncol2007;25(Suppl 1):Abstract 3538.

  • 148

    YauTChanPNgKK. Efficacy and tolerability of single agent sorafenib in poor risk advanced hepatocellular carcinoma patients [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 15513.

  • 149

    BartlettDLRamanthanRKBen-JosefE. Cancers of the biliary tree. In: DeVitaVTLawrenceTSRosenbergSA eds. Cancer: Principles & Practice of Oncology. 8th ed: Wolters Kluwer; Lippincott Williams & Wilkins; 2008:11561186.

  • 150

    PetrowskyHWildbrettPHusarikDB. Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol2006;45:4350.

  • 151

    CorveraCUBlumgertLHAkhurstT. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg2008;206:5765.

  • 152

    DuffyACapanuMAbou-AlfaGK. Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC). J Surg Oncol2008;98:485489.

  • 153

    JarnaginWRRuoLLittleSA. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer2003;98:16891700.

  • 154

    DonohueJHStewartAKMenckHR. The National Cancer Data Base report on carcinoma of the gallbladder, 1989–1995. Cancer1998;83:26182628.

  • 155

    D’AngelicaMDalalKMDematteoRP. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncolin press.

  • 156

    ReidKMRamos-De la MedinaADonohueJH. Diagnosis and surgical management of gallbladder cancer: a review. J Gastrointest Surg2007;11:671681.

  • 157

    JensenEHAbrahamAHabermannEB. A critical analysis of the surgical management of early-stage gallbladder cancer in the United States. J Gastrointest Surg2008; in press.

  • 158

    DainesWPRajagopalanVGrossbardMLKozuchP. Gallbladder and biliary tract carcinoma: a comprehensive update, part 2. Oncology (Williston Park)2004;18:10491059; discussion 1060 1065–1046 1068.

  • 159

    MalhiHGoresGJ. Cholangiocarcinoma: modern advances in understanding a deadly old disease. J Hepatol2006;45:856867.

  • 160

    PatelT. Cholangiocarcinoma. Nat Clin Pract Gastroenterol Hepatol2006;3:3342.

  • 161

    DeOliveiraMLCunninghamSCCameronJL. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg2007;245:755762.

  • 162

    ChapmanRW. Risk factors for biliary tract carcinogenesis. Ann Oncol1999;10(Suppl 4):308311.

  • 163

    RajagopalanVDainesWPGrossbardMLKozuchP. Gallbladder and biliary tract carcinoma: a comprehensive update, part 1. Oncology (Williston Park)2004;18:889896.

  • 164

    YamamotoSKuboSHaiS. Hepatitis C virus infection as a likely etiology of intrahepatic cholangiocarcinoma. Cancer Sci2004;95:592595.

  • 165

    EndoIGonenMYoppAC. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg2008;248:8496.

  • 166

    KimJYKimMHLeeTY. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol2008;103:11451151.

  • 167

    SeoSHatanoEHigashiT. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts lymph node metastasis, P-glycoprotein expression, and recurrence after resection in mass-forming intrahepatic cholangiocarcinoma. Surgery2008;143:769777.

  • 168

    LimJH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol2003;181:819827.

  • 169

    LimJHParkCK. Pathology of cholangiocarcinoma. Abdom Imaging2004;29:540547.

  • 170

    YamasakiS. Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg2003;10:288291.

  • 171

    PawlikTMNathanHAloiaT. A simplified staging system for intrahepatic cholangiocarcinoma [abstract]. Presented at the 2008 Gastrointestinal Cancers Symposium; January 25–27, 2008; Orlando, Florida. Abstract 194.

  • 172

    JarnaginWRFongYDeMatteoRP. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg2001;234:507517; discussion 517–509.

  • 173

    LieserMJBarryMKRowlandC. Surgical management of intrahepatic cholangiocarcinoma: a 31-year experience. J Hepatobiliary Pancreat Surg1998;5:4147.

  • 174

    YehCNJanYYYehTS. Hepatic resection of the intraductal papillary type of peripheral cholangiocarcinoma. Ann Surg Oncol2004;11:606611.

  • 175

    NakagohriTAsanoTKinoshitaH. Aggressive surgical resection for hilar-invasive and peripheral intrahepatic cholangiocarcinoma. World J Surg2003;27:289293.

  • 176

    IsajiSKawaradaYTaokaH. Clinicopathological features and outcome of hepatic resection for intrahepatic cholangiocarcinoma in Japan. J Hepatobiliary Pancreat Surg1999;6:108116.

  • 177

    BerdahSVDelperoJRGarciaS. A Western surgical experience of peripheral cholangiocarcinoma. Br J Surg1996;83:15171521.

  • 178

    SilvaMATekinKAytekinF. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol2005;31:533539.

  • 179

    HavlikRSbisaETulloA. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors. Hepatogastroenterology2000;47:927931.

  • 180

    CherquiDBenoistSMalassagneB. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg2000;135:302308.

  • 181

    HochwaldSNBurkeECJarnaginWR. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg1999;134:261266.

  • 182

    HeimbachJKHaddockMGAlbertsSR. Transplantation for hilar cholangiocarcinoma. Liver Transpl2004;10:S6568.

  • 183

    SudanDDeRooverAChinnakotlaS. Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. Am J Transplant2002;2:774779.

  • 184

    ReaDJHeimbachJKRosenCB. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg2005;242:451458; discussion 458–461.

  • 185

    DavidsPHGroenAKRauwsEA. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet1992;340:14881492.

  • 186

    PratFChapatODucotB. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc1998;47:17.

  • 187

    AbrahamNSBarkunJSBarkunAN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc2002;56:835841.

  • 188

    American Society for Gastrointestinal Endoscopy Technology Status Report. Photodynamic therapy for gastrointestinal disease. Gastrointest Endosc2006;63:927932.

  • 189

    DumoulinFLGerhardtTFuchsS. Phase II study of photodynamic therapy and metal stent as palliative treatment for nonresectable hilar cholangiocarcinoma. Gastrointest Endosc2003;57:860867.

  • 190

    OrtnerMECacaKBerrF. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology2003;125:13551363.

  • 191

    ZoepfTJakobsRArnoldJC. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol2005;100:24262430.

  • 192

    HezelAFZhuAX. Systemic therapy for biliary tract cancers. Oncologist2008;13:415423.

  • 193

    MojicaPSmithDEllenhornJ. Adjuvant radiation therapy is associated with improved survival for gallbladder carcinoma with regional metastatic disease. J Surg Oncol2007;96:813.

  • 194

    KayaharaMNagakawaT. Recent trends of gallbladder cancer in Japan: an analysis of 4,770 patients. Cancer2007;110:572580.

  • 195

    TakadaTAmanoHYasudaH. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer2002;95:16851695.

  • 196

    MacdonaldOKCraneCH. Palliative and postoperative radiotherapy in biliary tract cancer. Surg Oncol Clin N Am2002;11:941954.

  • 197

    CzitoBGAnscherMSWillettCG. Radiation therapy in the treatment of cholangiocarcinoma. Oncology (Williston Park)2006;20:873884; discussion 886–878 893–875.

  • 198

    NelsonJWGhafooriAPWillettCG. Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys2009;73:148153.

  • 199

    HughesMAFrassicaDAYeoCJ. Adjuvant concurrent chemoradiation for adenocarcinoma of the distal common bile duct. Int J Radiat Oncol Biol Phys2007;68:178182.

  • 200

    WangSJFullerCDKimJS. Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer. J Clin Oncol2008;26:21122117.

  • 201

    ShinoharaETMitraNGuoMMetzJM. Radiation therapy is associated with improved survival in the adjuvant and definitive treatment of intrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys2008;72:14951501.

  • 202

    BorgheroYCraneCHSzklarukJ. Extrahepatic bile duct adenocarcinoma: patients at high-risk for local recurrence treated with surgery and adjuvant chemoradiation have an equivalent overall survival to patients with standard-risk treated with surgery alone. Ann Surg Oncol2008;15:31473156.

  • 203

    LimKOhEChieE. Which is better in patients with curatively resected extrahepatic biliary tract cancer? Adjuvant concurrent chemoradiation alone versus CCRT followed by maintenance chemotherapy [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 15659.

  • 204

    DasPWolffRAAbbruzzeseJL. Concurrent capecitabine and upper abdominal radiation therapy is well tolerated. Radiat Oncol2006;1:41.

  • 205

    LinLLPicusJDrebinJA. A phase II study of alternating cycles of split course radiation therapy and gemcitabine chemotherapy for inoperable pancreatic or biliary tract carcinoma. Am J Clin Oncol2005;28:234241.

  • 206

    GlimeliusBHoffmanKSjodenPO. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol1996;7:593600.

  • 207

    RaoSCunninghamDHawkinsRE. Phase III study of 5FU, etoposide and leucovorin (FELV) compared to epirubicin, cisplatin and 5FU (ECF) in previously untreated patients with advanced biliary cancer. Br J Cancer2005;92:16501654.

  • 208

    KimTWChangHMKangHJ. Phase II study of capecitabine plus cisplatin as first-line chemotherapy in advanced biliary cancer. Ann Oncol2003;14:11151120.

  • 209

    DovalDCSekhonJSGuptaSK. A phase II study of gemcitabine and cisplatin in chemotherapy-naive, unresectable gall bladder cancer. Br J Cancer2004;90:15161520.

  • 210

    ThongprasertSNapapanSCharoentumCMoonprakanS. Phase II study of gemcitabine and cisplatin as first-line chemotherapy in inoperable biliary tract carcinoma. Ann Oncol2005;16:279281.

  • 211

    KnoxJJHedleyDOzaA. Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. J Clin Oncol2005;23:23322338.

  • 212

    KoeberleDSalettiPBornerM. Patient-reported outcomes of patients with advanced biliary tract cancers receiving gemcitabine plus capecitabine: a multicenter, phase II trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol2008;26:37023708.

  • 213

    AndreTTournigandCRosmorducO. Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR study. Ann Oncol2004;15:13391343.

  • 214

    NehlsOOettleHHartmannJT. Capecitabine plus oxaliplatin as first-line treatment in patients with advanced biliary system adenocarcinoma: a prospective multicentre phase II trial. Br J Cancer2008;98:309315.

  • 215

    KobayashiKTsujiAMoritaS. A phase II study of LFP therapy (5-FU (5-fluorourasil) continuous infusion (CVI) and low-dose consecutive (Cisplatin) in advanced biliary tract carcinoma. BMC Cancer2006;6:121.

  • 216

    EckelFSchmidRM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Br J Cancer2007;96:896902.

  • 217

    YonemotoNFuruseJOkusakaT. A multi-center retrospective analysis of survival benefits of chemotherapy for unresectable biliary tract cancer. Jpn J Clin Oncol2007;37:843851.

  • 218

    KimMJOhDYLeeSH. Gemcitabine-based versus fluoropyrimidine-based chemotherapy with or without platinum in unresectable biliary tract cancer: a retrospective study. BMC Cancer2008;8:374.

  • 219

    AlbertsSRAl-KhatibHMahoneyMR. Gemcitabine, 5-fluorouracil. And leucovorin in advanced biliary tract and gallbladder carcinoma. A North Central Cancer Treatment Group phase II trial. Cancer2005;103:111118.

  • 220

    GhafooriAPNelsonJWWillettC. Chemoradiation for inoperable extrahepatic cholangiocarcinoma [abstract]. Presented at the 2008 Gastrointestinal Cancers Symposium; January 25–27, 2008; Orlando, Florida. Abstract 166.

Article Information


Google Scholar

Related Articles


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 34 34 34
PDF Downloads 2 2 2
EPUB Downloads 0 0 0