Octreotide in Palliative Treatment of Unresectable Cholangiocarcinoma: Is it Effective for Disease Stabilization?

Letter to the Editor Cholangiocarcinoma is a dismal tumor, diffi cult to treat and in the majority of cases surgery is the only available method of cure, however only in early stages. 1 In advanced cases (turmors Klatskin III and IV) palliative therapy with endoscopic drainage of bile ducts is the only effective and acceptable method of treatment. 2 Adjuvant palliative therapies either with radiotherapy or chemotherapy in order to stabilize the disease gave controversial results and in some aspect unacceptable. 1–2 The need for new treatment to stabilize the disease, increase survival with acceptable quality of life is urgent. Somatostatin and its long-acting analogues have been successfully used in symptom control in patients with advanced neuroendocrine gastrointestinal tumours. 3,4 Moreover, octreotide, a somatostatin analogue, showed signifi cant effi cacy for the management of hepatocellular carcinoma in many studies and reviews. 5 Pistevou-Gombaki et al. 6,7 also reported a positive experience in liver metastases from non-neuroendocrine tumors with the use of octreotide LAR. A possible antitumor mechanism of octreotide is a stimulatory effect on Kupffer cells, induction of apoptosis or other antiproliferative actions, inhibition of proliferation, which have been suggested but not proved. The aim of the present study is to evaluate the role, if any, of octreotide in palliative treatment of end-stage, inoperable, cholangiocarcinomas (Klatskin III and IV tumors), taking into account the above-mentioned positive experience in relation to the absence of clear data and effi cacy of any available treatments in end-stage cholangiocarcinomas. We report on two male patients (A, B) 63-and 81-years-old, with obstructive icterus, due to advanced cholangiocarcinoma stage Klatskin III and IV respectively and liver metastases in patient A, who were palliatively treated by long acting octreotide IM (octreotide LAR) monthly, according to schema published previously, 7 in combination with successful endoscopic bile duct drainage. In both patients Klatskin tumor was demonstrated, in fi rst instance by abdominal echosonography and computed-tomography (CT), and thereafter by magnetic resonance imaging (MRI) and magnetic retrograde cholangiopancreatography (MRCP). Operation was excluded either due to advanced disease in patient A (liver metastases) and due to advanced age in patient B (81 years-old). Liver transplantation was also excluded due to advanced age and disease. Clinical examination revealed severe liver mass in both patients. Laboratory examination showed high bilirubin levels up to 30 mg/dl direct 20 mg/dl indirect 10 mg/dl, increased γ-GT, SGPT, ALF and highly increased tumor markers (CEA Ͼ1000 and …