這是一篇在網路上面搜尋到的文章，我把它做了一下翻譯放在這裡，網頁資料顯示最後更新日期是2013年九月10日，相關內容大家參考參考就好。文章中括號裡面開頭是PS的內容是我自己的想法，不是原文內容。
另外，因為時間的關係我可能沒有全部翻譯完畢，有空我會慢慢補完，不過我可能會跳著翻，藥物與用量的部分其實不太需要翻譯，真的要也是需要跟醫師討論。然後，我翻譯錯誤的地方，也麻煩各位儘速留言指正，再次重申，中文僅供參考，如有任何錯誤的地方，還是以原始網站刊登原文的內容為準。
Treatment Protocols
治療方法
Treatment protocols for biliary tract cancer are provided below, including surgery, adjuvant therapies, systemic therapies, and single-agent regimens.
膽道癌的治療方式如下所列，包含了手術，新形態治療方案，一般標準治療方案跟單一處方藥劑。
Surgical resection
手術切除
See the list below:
Surgery is the only curative modality for biliary tract cancers; surgical resectability of disease should be established by care teams who are experts in the field
手術是膽道癌的唯一治療方式；但是否能夠成功切除還是需要經過專業照護團隊的評估。
Criteria for resectability include absence of all of the following: retropancreatic and paraceliac nodal metastases or distant liver metastases, invasion of the portal vein or main hepatic artery (although some centers can offer vascular reconstruction), extrahepatic adjacent organ invasion, and disseminated disease
是否可以切除的評估標準包含了下列所有的項目：淋巴結沒有擴散到胰臟後（Retropancreatic）或 paraceliac 淋巴結，沒有遠處的肝轉移，沒有侵犯肝門靜脈或主要肝動脈(雖然有些醫學中心還是會建議做血管重建)，有無侵犯肝臟以外的器官，以及迷散性的傳染(PS.應該是指遠端移轉吧)
Surgical resection generally includes cholecystectomy, en bloc hepatic resection, and lymphadenectomy with or without bile duct excision, depending on the location of the tumor。
通常手術切除會包含到膽囊，整塊的肝臟，淋巴結等等，不論是否有受到膽管癌的侵犯，具體的切除範圍還是需要由腫瘤的所在位置來判斷。
If cancer is found incidentally at the time of surgery for other reasons and resectability is not clearly established or if the surgeon is not trained in the operation, then delayed open laparotomy is appropriate, as there is not a survival deficit compared to immediate resection。
如果在手術的過程當中有發現到其他的地方可能有腫瘤或者是一些其他的因素造成這個腫瘤可能沒有辦法切除乾淨，那麼最好就是不要切除，因為這樣的生存率可能比直接切除好。
Neoadjuvant therapy
輔助性療法
See the list below:
Neoadjuvant chemoradiotherapy is not currently a standard option for patients with biliary tract cancer。
輔助性療法並不是一般膽管癌患者的標準療法。
There is a small selected case series where 9 of 91 patients presenting with more advanced disease received chemoradiotherapy and all achieved an R0 resection ; however, a later study investigating chemoradiotherapy with 5-FU did not show a survival benefit ; more data are needed with longer follow-up before this approach can be recommended 。在一個小規模的研究當中，91個病患有9個末期病患在化學治療之後可以達到一個R0切除的程度；然而，在一個近期的研究中發現到化學治療的過程中，使用5-FU並沒有甚麼延長生存的效用；但是這個意見要能提出仍然需要有長期的追蹤資料來佐證。
Adjuvant therapy following curative-intent resection
輔助療法依照癌症分期來列示
(PS.癌症分期採用TNM分期方式，大家可以上網查一下)
Stage IB-III (T1-3, N0-1, M0):
在 1B期到第3期：
Data for adjuvant chemotherapy in patients with biliary tract cancers is very poor and, overall, does not show a significant survival benefit, but there may be some selected patients who derive benefit
就膽管癌患者來說，輔助療法的相關資料其實很少，整體來說，這些方式對於病人的生存率並沒有甚麼太大的幫助，但還是有些病患能藉此獲得延長生命。
Adjuvant chemoradiotherapy with a fluoropyrimidine should be strongly considered for patients with T2 or greater disease, microscopic positive margins, or positive regional lymph nodes。
當病人的癌症分期是在二期、microscopic positive margins(PS.明顯可見的感染?)，或是有感染到淋巴結的時候，氟嘧啶(PS.其實5-FU就是屬於嘧啶類似物)類的藥物是輔助性化學治療法施行時建議要考慮的藥物。
Consideration can also be made for an additional 4mo of a fluoropyrimidine- or gemcitabine-based therapy in patients with extrahepatic cholangiocarcinoma with either positive margins or positive regional lymph nodes。
Recommendations for radiation therapy in the adjuvant setting stem from high rates of local failure following surgery, and a retrospective analysis of patients receiving adjuvant radiotherapy shows an initial survival benefit; however, a longer-term follow-up series suggests that this benefit may be lost after more than 5 years.
Adjuvant chemoradiotherapy regimens for stage IB-III:
5-FU 225 mg/m2 IV daily during radiation or
5-FU 500 mg/m2 IV bolus on days 1-3 and days 29-31 during radiation or
Capecitabine 825 mg/m2 PO twice daily during radiation ; following radiation, consider an additional 4mo of therapy or
Capecitabine 1000 mg/m2 PO twice daily for 14 of every 21d or
Capecitabine 800-900 mg/m2 PO BID on days of radiation
For those with aggressive or high-risk disease (positive margins) or multiple positive lymph nodes, consider switching to a gemcitabine-based regimen (see Systemic therapy, below).
Systemic therapy for nonresectable or metastatic disease
無法切除或有移轉時的全身治療
Selected stage III-IV (T3-4, Any N, M0-1):
第三、四期(TNM分期屬於T3N0M0~T4N3M1)
Standard-of-care front-line chemotherapy for patients with good performance status (ECOG score ≤2):
病人狀態不錯時(ECOG評分要小於等於2)，病人在化療時的標準處理方式：
Cisplatin 25 mg/m2 IV on days 1 and 8 plus gemcitabine 1000 mg/m2 IV on days 1 and 8; then every 21d for up to 24wk or until disease progression
在第一天及第八天時，使用25mg/m2的順鉑跟1000mg/m2的健擇採點滴注射，然後每21天重複一次，直到24周結束或者狀況改善。
Other acceptable regimens for good performance status patients (gemcitabine regimens favored):
ECOG分數小於等於2的病人其他可接受的方案(健擇是較佳選擇).
Gemcitabine 1000 mg/m2 IV on day 1 plus oxaliplatin 100 mg/m2 IV on day 2; then every 14d until progression or toxicity(第一天採用1000mg/m2的健擇注射，第二天則使用100mg/m2的草鉑；然後每14天重複一次直到病況改善或產生毒性反應) or
Gemcitabine 1000 mg/m2 IV on days 1 and 8 plus capecitabine 650 mg/m2 PO on days 1-14; then every 21d until progression or toxicity(或者第一天及第八天採用1000mg/m2的健擇注射，然後第一天到第14天每天服用650mg/m2的截瘤達；然後每21天重複一次直到病況改善或產生毒性反應) or
Capecitabine 1000 mg/m2 PO twice daily on days 1-14 plus oxaliplatin 130 mg/m2 IV on day1; then every 21d until progression or toxicity (或者第一天到第14天每兩天服用1000mg/m2的截瘤達，第一天並點滴注射130mg/m2的草鉑；然後每21天重複一次直到病況改善或產生毒性反應)or
Leucovorin 400 mg/m2 IV infused over 2h prior to 5-FU plus 5-FU 400 mg/m2 IV bolus on day 1, followed by 2400 mg/m2 IV infused over 46h plus oxaliplatin 100 mg/m2 IV on day 1; then every 14d until progression or toxicity(或者第一天先以靜脈輸注400mg/m2的葉酸兩小時以上，並用針筒輸注 400mg/m2的5-FU到第14天每兩天服用1000mg/m2的截瘤達，第一天並點滴注射130mg/m2的草鉑；然後每21天重複一次直到病況改善或產生毒性反應) or
Capecitabine 1250 mg/m2 PO twice daily on days 1-14 plus cisplatin 60 mg/m2 IV on day 1; then every 21d until progression or toxicity or
5-FU 1000 mg/m2/day via continuous IV infusion on days 1-5 plus cisplatin 100 mg/m2 IV on day 2; then every 4wk until progression or toxicity
Single-agent regimens for patients with poorer performance status (ECOG score > 2) :
Gemcitabine 1000 mg/m2 IV on days 1 and 8; then every 21d until progression or toxicity or
Capecitabine 1000 mg/m2 PO twice daily for 14d; then every 21d until progression or toxicity[8] or
5-FU 425 mg/m2 IV bolus plus folinic acid 20 mg/m2 IV; then weekly until progression or toxicity or
Docetaxel 100 mg/m2 IV; then every 21d until progression or toxicity
Special considerations
特別要注意的事情
See the list below:
Chemotherapy should generally be reserved for patients with good performance status
化學治療的執行通常病患需要有比較好的身體狀況
Palliative biliary drainage is often necessary in patients with advanced unresectable biliary tract carcinoma
姑息性的膽道引流對於無法手術切除的病患通常會有需要
Percutaneous biliary drainage is usually more successful and has a lower complication rate than endoscopic stenting
經皮穿肝引流術一般來說比起膽管支架放置來說效果會比較好，而且會有比較低的感染發生率。
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