Part 3 - … ls-part-3/

Part 4 - … ls-part-4/

Science Surgery: ‘What factors lead to a cell becoming cancerous?’ … cancerous/

L1 Cell Adhesion Molecule Promotes Migration and Invasion via JNK Activation in Extrahepatic Cholangiocarcinoma Cells with Activating KRAS Mutation.

Comparison of intraluminal radiofrequency ablation and stents vs. stents alone in the management of malignant biliary obstruction.

Clinical and survival outcomes of percutaneous microwave ablation for intrahepatic cholangiocarcinoma.

That's next Sunday everyone!

Please take a look here - … nnual-NCSD

"As part of the 30th annual National Cancer Survivors Day®, cancer survivors and supporters in communities around the world will unite on Sunday, June 4, 2017, to celebrate life and raise awareness of the challenges faced by cancer survivors."

Start spreading the news!

Hugs to all,


Great post Karen, thanks loads for that!

Brachytherapy in the treatment of bile duct cancer - a tough challenge

Ooops, forgot the link -

RFA for Malignant Biliary Obstruction

Currently Recruiting.

Please note that information regarding clinical trials is being provided for informational purposes only. The Cholangiocarcinoma Foundation does not endorse any specific clinical trial. Please discuss any questions you may have about clinical trials with your healthcare provider.

Pancreatic cancer and cholangiocarcinoma are the most common causes of malignant biliary obstruction. They are diseases of increasing incidence and unfavorable prognosis. Only a minority of patients have a localized disease and are indicated for surgery with a chance of long-term survival. Locally advanced and metastatic tumors are treated with palliative chemotherapy or chemoradiotherapy; the results of such treatments are unsatisfactory. The average survival of patients with unresectable disease is 6 months and only 5 - 10 % of patients survive 5 years. Chemotherapy and radiotherapy can be used, however only with a palliative effect. Biliary drainage is an integral part of palliative treatment. Endoscopically or percutaneously placed stents improve quality of life, decrease cholestasis and pruritus, but do not significantly improve survival. Biliary stents get occluded over time, possibly resulting in acute cholangitis and require repeated replacement. Endoluminal biliary photodynamic therapy (PDT) and radiofrequency ablation (RFA), locally active endoscopic methods, have been increasingly used in recent years in palliative treatment of patients with malignant biliary obstruction. In photodynamic therapy, improved survival has been shown in two randomized controlled trials; however the technique suffers from technical complexity, high cost and low availability. In RFA, application of low voltage high frequency current during radiofrequency ablation results in tissue destruction by heat. Its antitumor effect may also be related to systemic changes in antitumor immunity. The use of endoluminal biliary RFA has so far been reported only in small retrospective cohorts of patients.

The aim of this randomized study is to compare efficacy of RFA plus stenting to stenting alone in palliative treatment of malignant biliary obstruction with survival as primary outcome. Secondary outcomes are stent patency, immediate and late complications, quality of life and effects on anti-tumor immunity in the RFA group.

Condition    Intervention
Pancreas Cancer
Procedure: Radiofrequency ablation
Procedure: Biliary stenting

Study Type:    Interventional
Study Design:    Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:
Randomized controlled study
Masking: No masking
Primary Purpose: Treatment
Official Title:    Radiofrequency Ablation Plus Stenting Versus Stenting Alone for Treatment of Malignant Biliary Obstruction

Resource links provided by NLM:

Genetics Home Reference related topics: cholangiocarcinoma
U.S. FDA Resources

Further study details as provided by Institute for Clinical and Experimental Medicine:

Primary Outcome Measures:
Survival [ Time Frame: 12 months ]
number of days/months of survival (being alive) post intervention

Secondary Outcome Measures:
Stent patency [ Time Frame: 12 months ]
number of days/months of patent stent (not occluded) post intervention

Complications [ Time Frame: 30 days ]
number of complications related to procedure (bleeding, perforation, cholangitis will be combined to report as a complication)

Quality of life [ Time Frame: 12 months ]
validated questionnaire investigating quality of live post intervention

Augmentation of antitumor immunity [ Time Frame: 30 days ]
serum level of HSP 70 and selected cytokines will be measured from blood

Estimated Enrollment:    140
Anticipated Study Start Date:    June 8, 2017
Estimated Study Completion Date:    May 8, 2020
Estimated Primary Completion Date:    May 8, 2019 (Final data collection date for primary outcome measure)
Arms    Assigned Interventions
Experimental: RFA plus stenting
Endoluminal radiofrequency ablation followed by biliary stenting
Procedure: Radiofrequency ablation
Endoluminal radiofrequency ablation using a ERC-based catheter
Procedure: Biliary stenting
Placing a metal or plastic stent in the bile duct
Active Comparator: Stenting alone
Biliary stenting alone
Procedure: Biliary stenting
Placing a metal or plastic stent in the bile duct

   Show Detailed Description


Ages Eligible for Study:      18 Years and older   (Adult, Senior)
Sexes Eligible for Study:      All
Accepts Healthy Volunteers:      No
Inclusion Criteria:

Age over 18
Pathologically confirmed malignant bile duct obstruction (cholangiocarcinoma or pancreatic cancer)
Laboratory signs of biliary obstruction
Non-resectable disease (distant metastasis, locally advanced disease, patient related factors) based on a multidisciplinary team decision
Capability of giving informed consent
Life expectancy greater than 3 months
Exclusion Criteria:

Unstable for ERC
Inability to give informed consent
Uncorrected coagulopathy
Concomitant biliary oncological endoluminal therapy (photodynamic therapy, brachytherapy)
Cardiac pacemaker
   Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT03166436

Contact: Tomas Hucl, MD, PhD    00420261362600   
Contact: Petra Truxova, Ing    00420261362619   

Department of Gastroenterology and Hepatology    Recruiting
Prague, Czechia, 14021
Contact: Tomas Hucl, MD, PhD    00420261362600   
Contact: Petra Truxova, Ing    00420261362619   
Sponsors and Collaborators
Institute for Clinical and Experimental Medicine
Principal Investigator:    Tomas Hucl, MD, PhD    IKEM
  More Information

Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology. 2013 Dec;145(6):1215-29. doi: 10.1053/j.gastro.2013.10.013. Epub 2013 Oct 15. Review.
Khan SA, Davidson BR, Goldin RD, Heaton N, Karani J, Pereira SP, Rosenberg WM, Tait P, Taylor-Robinson SD, Thillainayagam AV, Thomas HC, Wasan H; British Society of Gastroenterology.. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012 Dec;61(12):1657-69. doi: 10.1136/gutjnl-2011-301748. Epub 2012 Aug 15.
Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, Khor CJ, Ponnudurai R, Moon JH, Seo DW, Pantongrag-Brown L, Sangchan A, Pisespongsa P, Akaraviputh T, Reddy ND, Maydeo A, Itoi T, Pausawasdi N, Punamiya S, Attasaranya S, Devereaux B, Ramchandani M, Goh KL; Asia-Pacific Working Group on Hepatobiliary Cancers.. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol. 2013 Apr;28(4):593-607. doi: 10.1111/jgh.12128. Review.
Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2011 Aug 13;378(9791):607-20. doi: 10.1016/S0140-6736(10)62307-0. Epub 2011 May 26. Review.
Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992 Dec 19-26;340(8834-8835):1488-92.
Sangchan A, Kongkasame W, Pugkhem A, Jenwitheesuk K, Mairiang P. Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc. 2012 Jul;76(1):93-9. doi: 10.1016/j.gie.2012.02.048. Epub 2012 May 15.
Ortner ME, Caca K, Berr F, Liebetruth J, Mansmann U, Huster D, Voderholzer W, Schachschal G, Mössner J, Lochs H. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology. 2003 Nov;125(5):1355-63.
Zoepf T, Jakobs R, Arnold JC, Apel D, Riemann JF. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol. 2005 Nov;100(11):2426-30.
Curley SA, Izzo F. Radiofrequency ablation of primary and metastatic hepatic malignancies. Int J Clin Oncol. 2002 Apr;7(2):72-81. Review.
Shaheen NJ, Overholt BF, Sampliner RE, Wolfsen HC, Wang KK, Fleischer DE, Sharma VK, Eisen GM, Fennerty MB, Hunter JG, Bronner MP, Goldblum JR, Bennett AE, Mashimo H, Rothstein RI, Gordon SR, Edmundowicz SA, Madanick RD, Peery AF, Muthusamy VR, Chang KJ, Kimmey MB, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Dumot JA, Falk GW, Galanko JA, Jobe BA, Hawes RH, Hoffman BJ, Sharma P, Chak A, Lightdale CJ. Durability of radiofrequency ablation in Barrett's esophagus with dysplasia. Gastroenterology. 2011 Aug;141(2):460-8. doi: 10.1053/j.gastro.2011.04.061. Epub 2011 May 6.
Zacharoulis D, Lazoura O, Sioka E, Potamianos S, Tzovaras G, Nicholls J, Koukoulis G, Habib N. Habib EndoHPB: a novel endobiliary radiofrequency ablation device. An experimental study. J Invest Surg. 2013 Feb;26(1):6-10. doi: 10.3109/08941939.2012.681832. Epub 2012 Dec 28.
Steel AW, Postgate AJ, Khorsandi S, Nicholls J, Jiao L, Vlavianos P, Habib N, Westaby D. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc. 2011 Jan;73(1):149-53. doi: 10.1016/j.gie.2010.09.031.
Sharaiha RZ, Natov N, Glockenberg KS, Widmer J, Gaidhane M, Kahaleh M. Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures: is there an added benefit? Dig Dis Sci. 2014 Dec;59(12):3099-102. doi: 10.1007/s10620-014-3264-6. Epub 2014 Jul 18.
Monga A, Gupta R, Ramchandani M, Rao GV, Santosh D, Reddy DN. Endoscopic radiofrequency ablation of cholangiocarcinoma: new palliative treatment modality (with videos). Gastrointest Endosc. 2011 Oct;74(4):935-7. doi: 10.1016/j.gie.2010.10.018. Epub 2010 Dec 18.
Dolak W, Schreiber F, Schwaighofer H, Gschwantler M, Plieschnegger W, Ziachehabi A, Mayer A, Kramer L, Kopecky A, Schrutka-Kölbl C, Wolkersdörfer G, Madl C, Berr F, Trauner M, Püspök A; Austrian Biliary RFA Study Group.. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc. 2014 Mar;28(3):854-60. doi: 10.1007/s00464-013-3232-9. Epub 2013 Oct 3.
Kallis Y, Phillips N, Steel A, Kaltsidis H, Vlavianos P, Habib N, Westaby D. Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit. Dig Dis Sci. 2015 Nov;60(11):3449-55. doi: 10.1007/s10620-015-3731-8. Epub 2015 Jun 3.
Tal AO, Vermehren J, Friedrich-Rust M, Bojunga J, Sarrazin C, Zeuzem S, Trojan J, Albert JG. Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction. World J Gastrointest Endosc. 2014 Jan 16;6(1):13-9. doi: 10.4253/wjge.v6.i1.13.
Wu F. Heat-Based Tumor Ablation: Role of the Immune Response. Adv Exp Med Biol. 2016;880:131-53. doi: 10.1007/978-3-319-22536-4_8. Review.
Witzigmann H, Berr F, Ringel U, Caca K, Uhlmann D, Schoppmeyer K, Tannapfel A, Wittekind C, Mossner J, Hauss J, Wiedmann M. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg. 2006 Aug;244(2):230-9.

Responsible Party:    Tomas Hucl, Vice-chairman, Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine Identifier:    NCT03166436     History of Changes
Other Study ID Numbers:    IKEM RFA CCA PC
Study First Received:    May 14, 2017
Last Updated:    May 23, 2017
Individual Participant Data    
Plan to Share IPD:    No

Studies a U.S. FDA-regulated Drug Product:    No
Studies a U.S. FDA-regulated Device Product:    No
Additional relevant MeSH terms:
Pancreatic Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Digestive System Neoplasms
Neoplasms by Site
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases processed this record on May 25, 2017

This as well from the FDA -

FDA approves first cancer treatment for any solid tumor with a specific genetic feature … 560167.htm

Brachytherapy in the treatment of bile duct cancer - a tough challenge

A single-center experience of sorafenib monotherapy in patients with advanced intrahepatic cholangiocarcinoma.

Left hepatectomy with simultaneous hepatic artery and portal vein reconstructions in the operation for cholangiocarcinoma: the surgical techniques comprised of step-by-step established procedures.

Preoperative biliary drainage versus direct surgery for perihilar cholangiocarcinoma: A retrospective study at a single center.

About time!!! Great stuff, thanks for posting Marion.

I take it this is the actual link Marion? … 048383.htm

And just to add to what you said Positivity, to anyone considering another alternative treatment etc, please please please at the very least come to here and look for info, opinions etc on it. That as well as talking with your med team of course.


Thanks for that Marion.

Part 1 - … ls-part-1/

Part 2 - … ls-part-2/

Poor prognosis in cholangiocarcinoma patients with low FBXW7 expression is improved by chemotherapy.

Go get em Marion!!!!!


miR-106b regulates the 5-fluorouracil resistance by targeting Zbtb7a in cholangiocarcinoma.


(4 replies, posted in In Remembrance)

Dear Joe,

I am so very sorry indeed to hear of the passing of your beloved mum  Helena.  Please accept my sincerest condolences and know that right now my thoughts are with you and your family right now.  What a lovely tribute you all gave to your mum with that video, thanks so much for sharing that with us all. Please know as well that we are all here for you.

Thinking of you right now.


Adjuvant capecitabine for biliary tract cancer: The BILCAP randomized study.

ASCO link here.

Adjuvant capecitabine for biliary tract cancer: The BILCAP randomized study.