Stent placement combined with intraluminal radiofrequency ablation and hepatic arterial infusion chemotherapy for advanced biliary tract cancers with biliary obstruction: a multicentre, retrospective, controlled study

Abstract

Objective To evaluate the efficacy and safety of stent placement combined with intraluminal radiofrequency ablation (intra-RFA) and hepatic arterial infusion chemotherapy (HAIC) for patients with advanced biliary tract cancers (Ad-BTCs) and biliary obstruction (BO). Methods We retrospectively reviewed data for patients with Ad-BTCs and BO who underwent stent placement with or without intra-RFA and HAIC in three centres between November 2013 and November 2018. The stent patency time (SPT), overall survival (OS), and adverse events (AEs) were analysed. Results Of the 135 enrolled patients, 64 underwent stent placement combined with intra-RFA and HAIC, while 71 underwent only stent placement. The median SPT was significantly longer in the combination group (8.2 months, 95% confidence interval [CI]: 7.1–9.3) than in the control group (4.3 months, 95% CI: 3.6–5.0; p < 0.001). A similar result was observed for OS (combination: 13.2 months, 95% CI: 11.1–16.5; control: 8.5 months, 95% CI: 7.6–9.6; p < 0.001). The incidence of AEs related to biliary tract operation was not significantly different between the two groups (p > 0.05). The most common AE and serious AE related to HAIC were alanine aminotransferase elevation (24/64; 37.5%) and thrombocytopenia (8/64; 12.5%), respectively. All AEs were tolerable, and there was no death from AEs. Conclusions Stent placement combined with intra-RFA and HAIC may be a safe, potential treatment strategy for patients with Ad-BTCs and BO. Key Points • Advanced biliary cancers (Ad-BTCs) with biliary obstruction (BO) can rapidly result in liver failure and cachexia with an extremely poor prognosis. • Stent placement combined with intraluminal radiofrequency ablation and hepatic arterial infusion chemotherapy may be safe and effective for patients with Ad-BTCs and BO. • The long-term efficacy and safety of the combined treatment is promising.

[Retracted] Value of Multislice Spiral CT in Differential Diagnosis of Thick‐Wall Gallbladder Carcinoma and Chronic Cholecystitis

“…Bile duct dilation is an indirect sign of gallbladder cancer, which is triggered by bile duct compression, tumor invasion of the common bile duct, and tumor spread through the bile duct [ 14 ]. Low biliary tract obstruction is caused by bile duct dilation causing stones to enter the lower common bile duct, and high biliary tract obstruction is caused by Mirizzi syndrome [ 15 , 16 ]. Patients with chronic cholecystitis are less likely to have high or low obstruction because of the absence of bile duct dilation.…”

Comparison of Intraductal RFA Plus Stent versus Stent-Only Treatment for Unresectable Perihilar Cholangiocarcinoma—A Systematic Review and Meta-Analysis

“…In the meta-analysis, a total of 511 patients were included across nine studies [23][24][25][26][27][28][29][30][31]. Of these patients, 217 received RFA + stent placement and 294 underwent stent placement without RFA.…”

“…Of these patients, 217 received RFA + stent placement and 294 underwent stent placement without RFA. Six studies included all four Bismuth-Corlette types of pCCA [24,26,27,[29][30][31], as specified in Table 1. Five studies were performed in Asia [24,[27][28][29]31], two in the USA [26,30] and two in Europe [23,25].…”

“…Five studies used an endoscopic approach [25,26,28,30,31], three used a percutaneous approach only [23,27,29] and one did not specify the method [24]. The type of stents placed were plastic and SEMSs in three studies [25,30,31], SEMSs only in three studies [23,27,29], plastic stents only in two studies [24,28] and one study did not report the type of stent placed [26]. Four studies specified chemo(radio)therapy as additional treatment [23,25,29,30].…”

“…The type of stents placed were plastic and SEMSs in three studies [25,30,31], SEMSs only in three studies [23,27,29], plastic stents only in two studies [24,28] and one study did not report the type of stent placed [26]. Four studies specified chemo(radio)therapy as additional treatment [23,25,29,30]. The characteristics of the studies included in the meta-analysis are further described in Table 1.…”