Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Abstract

Background/Aims: To prospectively evaluate our palliative management of unresectable cholangiocarcinoma (CC) treated with tailored multimodal oncological therapy. Methods: Between January 2005 and January 2010, 50 consecutive patients with unresectable CC and jaundice were palliated with percutaneous drainage. Forty-three patients underwent metallic-stent implantation followed by brachytherapy. Patients were divided into two arms: the intra-arterial chemotherapy arm (IA arm, n=17) consisted of patients treated with locoregional treatment (IA admission of Cisplatin and 5-fluorouracil, or chemoembolization with Lipiodol) and/or systemic chemotherapy, while the systemic chemotherapy arm (IV arm, n=23) included all the other patients, who were treated only with systemic chemotherapy. Results: In total, 78 metal self-expandable stents were placed. Hilar involvement with mass-forming and periductal infiltrating types of CC (84%) was predominant. The average number of percutaneous interventional procedures was 11.61 per patient (range, 4-35). The median overall survival from diagnosis of disease for all patients was 13.5 months (range, 11.0-18.8 months). The median overall survival times were 25.2 months (range, 15.2-31.3 months) and 11.5 months (range, 8.5-12.6 months) in the IA and IV arms, respectively (p＜0.05). The 1-, 2-, and 3-year survival rates in the IA and IV arms were 88.2%, 52.9%, and 10.1% and 43.5%, 25.4, and 0%, respectively. There were no major complications (WHO III/IV) due to interventional procedures. Conclusions: We could reach acceptable prognosis in patients with unresectable CC using complex tailored oncological therapy. However, the main limitations of prolonging survival are performance status, patient compliance and the maintaining of biliary tract patency. (Gut Liver 2010;4(Suppl. 1):S82-88)

Biliary stenting for unresectable cholangiocarcinoma: A population‐based study of long‐term outcomes and hospital costs in Taiwan

“…However, the difference did not reach statistical significance (Table 4). In a prospective study by Andra sina et al [30], favorable prognoses were achieved by a complex tailored oncological therapy comprising stent, brachytherapy, and chemotherapy. Another retrospective analysis revealed that, for unresectable hilar CC, a multimodal approach combining percutaneous stenting with radiotherapy and chemotherapy is an effective alternative to palliative surgery [31].…”

Locoregional Therapies of Cholangiocarcinoma

“…For the future, complex multimodal concepts are the key to further improve progression-free and overall survival as well as the quality of life in patients with CC in different stages. For example, Andrasina et al [44] presented an interdisciplinary approach for symptomatic irresectable ICC and ECC by means of biliary stent implantation, brachytherapy, and chemotherapy. After successful biliary drainage (metallic stent placement and intraluminal brachytherapy), patients were assigned either to an arm with transarterial chemotherapy (for patients with hypervascular tumors) or to an arm with intravenous chemotherapy (for patients with hypovascular tumors).…”

“…In the first review, Ray et al [41] included 16 studies with a total of 542 patients undergoing chemotherapy-based transarterial therapy, whereas in all studies - except in the study by Andrasina et al [44] - repetitive TACE was performed in a typical fashion with transarterial injection of one or more chemotherapeutic agents and one or more embolic agents [41]. After pooling, the tumor control, severe toxicity, 30-day mortality, and 1-year overall survival rates were 76.8, 18.9, 0.7, and 58.0%, respectively.…”

Imaging and interventions in hilar cholangiocarcinoma: A review

“…The primary advantage of intraluminal brachytherapy over external beam radiotherapy is that higher doses of irradiation can be given without damaging adjacent normal tissues [58] . This procedure is usually done through PTBD route, preferably after metallic stent placement.…”