Gem/Cis or Capecitabine/radiation?

My husband (54) has cc that would be resectable if he did not also have cirrhosis. The surgeons believe that the resection would not leave him with enough viable liver to sustain him. So, we are looking at palliative therapies, with a long-shot potential of liver transplant down the road if we can stabilize the tumor.

Here at Duke, they had him scheduled for Capecitabine and radiation for 5.5 weeks. We put that off for a few weeks so we could travel to MD Anderson and meet with Dr. Javle. He recommended not doing radiation at this time, as the tumor is located along the left branch of the duct, partially up the right, as well as the common duct. He feels that irradiating this large of an area would negatively impact the surrounding tissues (liver, pancreas, intestine, kidney) and he recommends IV chemo with Gem/Cis and re-scan in 3 months. He said, if we can show containment or shrinkage of the tumor that can be maintained over a long period of time, John may be able to appeal to the liver board under their “extended criteria” for transplant and possibly get a “second tier” liver.

Dr. Chapman said we should biopsy the enlarged lymph nodes in the abdomen, and if those are clear, he would want to see John in person to evaluate him as a potential liver transplant candidate (Dr. Chapman has not seen John – just his records). Dr. Chapman’s protocol seems to consist of chemo/radiation followed by transplant.

John is having the biopsy on Monday. If the nodes are clear, I’m not sure what to do. Going to St. Louis would delay treatment at least another week (we’ve already been delayed 3 weeks due to the trip to Houston and the holiday. He was diagnosed in late October). I’m thinking, if the nodes are clear, I would talk to Dr. Chapman and discuss their protocol vs. Dr. Javle’s and see what he recommends.

Any advice from those of you who have been through this?

Thanks,

Mary