AB130. 94. The Irish experience of the Mayo Protocol for unresectable hilar cholangiocarcinoma

Background: Pioneered by the Mayo Clinic, multimodal therapy with neoadjuvant chemoradiotherapy (nCRT) and orthotopic liver transplant (OLT) has emerged as a promising option for unresectable hilar cholangiocarcinoma (hCCA), a disease otherwise associated with a dismal prognosis. Long-term outcome data is limited however, and concern exists surrounding reproducibility of results and justification of scare liver grafts. This study reports the experience of the Irish National Liver Transplant Programme with the Mayo Protocol.

Methods: All patients diagnosed with unresectable hCCA between 2004 and 2016 who were eligible for the treatment protocol were prospectively studied.

Results: Thirty-seven patients were deemed eligible for the treatment protocol and commenced CRT. Of those, 11 were excluded due to disease progression and 26 proceeded to OLT. There were 24 males and the median age was 49. R0 and pCR rates were 96% and 62% respectively. Overall median survival was 99 months and 1-, 3- and 5-year survival were 80%, 68% and 52%. The median survival of patients achieving a pathologic complete response (pCR) was 83.8 months compared with 20.9 months in the group with residual disease (P=0.036). Six patients (23%) developed disease recurrence. Among the patients who developed metastatic disease during neoadjuvant treatment, median survival was 10.5 months compared to 107.7 months in patients who proceeded to transplant (P<0.001).

Conclusions: Neoadjuvant chemoradiotherapy followed by OLT substantially increases the survival of patients with unresectable hCCA. Pathologic response is an important predictor of outcome and achieving a pCR confers a significant survival benefit.

Keywords: Cholangiocarcinoma; chemoradiotherapy; liver transplant