Clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization combined with radiotherapy in hilar cholangiocarcinoma

Abstract

BACKGROUND Radical surgical resection is regarded as the best treatment for hepatic hilar cholangiocarcinoma. However, 60%-70% of patients have lost the chance of surgery at the time of diagnosis. Simple biliary stent or drainage tube placement may fail in a short time due to tumor invasion or overgrowth, bile accumulation, or biofilm formation. Effective palliative treatments to extend the effective drainage time are of great significance for improving the quality of life of patients and changing the prognosis of patients. AIM To investigate the clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization (TACE) combined with radiotherapy in hilar cholangiocarcinoma. METHODS A retrospective analysis was conducted on patients clinically diagnosed with hilar cholangiocarcinoma from June 2014 to January 2017 at the Liaoning Provincial Cancer Hospital. Patients were evaluated by specialists, and those who were not suitable for surgery or unwilling to undergo surgery and met the inclusion criteria were included in the study. There were a total of 72 patients (34 males and 38 females) with an average age of 59.9 years (range, 40-72 years). According to percutaneous transhepatic biliary angiography and the patients’ wishes, stent implantation or biliary drainage tube implantation was used to relieve biliary obstruction. The patients were divided into either a control group or a combined treatment group according to their follow-up treatment. The control group consisted of a total of 35 patients who received simple biliary drainage tube placement and biliary stent implantation (7 patients with bilateral stents and 6 with a unilateral stent) and 22 patients receiving biliary drainage tube placement alone. The combined treatment group received TACE and extracorporeal radiotherapy after biliary drainage or biliary stent implantation and consisted of a total of 37 patients, including 21 patients receiving combined treatment after biliary stent placement (14 patients with bilateral stents and 7 with a unilateral stent) and 16 undergoing combined therapy after implanting the biliary drainage tube. In the combination treatment group, the TACE chemotherapy regimen employed gemcitabine and cisplatin, and the embolic agent was iodized oil. A particular dose was determined according to the patient's body surface area and the tumor staining indicated by DSA. In vitro radiotherapy was performed with intensity-modulated radiotherapy or three-dimensional conformal radiotherapy at an average dose of 48.3 Gy. Both groups were followed from stent implantation or drainage tube implantation until the patient quitted or died. The median length of follow-up observation was 13 mo. The differences in overall survival time and the effect of different jaundice reducing methods (single stent, double stent, or biliary drainage) on the patency time and survival time of biliary stents were compared between the two ...

Novel brachytherapy drainage tube loaded with double 125I strands for hilar cholangiocarcinoma: A case report

“…However, for patients with type IV, it is necessary to combine hepatectomy and the reconstruction of the portal vein and hepatic artery, and also to eliminate the residual cancer cells at each margin to achieve radical resection[ 6 ]. Surgical resection alone is not the best method for the treatment of hilar CC[ 7 , 8 ]. For patients with unresectable hilar CC, standard combination therapy should be used, including intracavitary brachytherapy, chemotherapy with gemcitabine and cisplatin, or liver transplantation[ 1 , 2 ].…”

Intra-arterial chemotherapy in the treatment of inoperable patients with Klatskin tumor: preliminary results

“…Zheng с соавт. [16] использовали сочетание масляной химиоэмболизации с гемцитабином, цисплатином, липиодолом (при технической неосуществимости выполняли химиоинфузии) и лучевой терапии в дозе 48,3 Гр у 37 больных раком ворот печени: медиана выживаемости составила 20,0 мес против 10,5 мес в контрольной группе (дренирование/стентирование). Тяжелых осложнений не было.…”

A Novel Microcrystalline BAY-876 Formulation Achieves Long-Acting Antitumor Activity Against Aerobic Glycolysis and Proliferation of Hepatocellular Carcinoma

“…Various interventional treatment strategies represented by transhepatic arterial chemoembolization (TACE) aim to achieve precise administration of HCC anti-tumor therapy (49,106). DSAguided transhepatic arterial chemoembolization or CT-guided percutaneous puncture can realize the direct administration of drugs to tumor tissues (107)(108)(109)(110). At the same time, the most commonly used and latest technology is various drug sustainedrelease microspheres, which can achieve long-acting and sustained release of drugs in tumor tissues (111)(112)(113)(114).…”