The Role of Conventional and Stereotactic Microwave Ablation for Intrahepatic Cholangiocarcinoma

Abstract

Background: The incidence and mortality of intrahepatic cholangiocarcinoma (ICCA) is increasing worldwide and curative treatment options are limited due to the aggressive tumor biology and often late diagnosis. Resection of the primary tumor remains the only curative therapy available, as the benefit of palliative chemotherapy and radiotherapy is relatively small. In contrast to hepatocellular carcinoma, minimal-invasive thermal tumor ablation, and in particular stereotactic tumor ablation for small primary cancers or metastases, is not established and data are scarce. Methods: We conducted a literature review in the field of ICCA ablation and retrospective analysis of 10 patients treated by stereotactic microwave ablation (SMWA) for either primary ICCA or liver metastases of ICCA. Results: While current guidelines have no consensus for ablation of primary ICCA, some state that it might be an option in inoperable patients or those with recurrent disease. The literature review revealed 11 studies on microwave ablation for ICCA reporting that MWA for ICCA ≤ 5 cm might be safe and could be a treatment option for patients who are not candidates for surgery. No data has been published on stereotactic microwave ablation (SMWA) for ICCA. The analyses of our own data of 10 patients treated by SMWA for primary ICCA (n = 5) or recurrent ICCA (n = 5) show that the treatment is safe and efficient with short hospital stays and low complication rates. Conclusion: Although thermal ablation, and in particular SMWA, might be a minimally invasive and tissue-sparing curative treatment alternative for small ICCA in the diseased liver and ICCA metastases, the oncologic benefit still needs to be shown in larger studies with longer follow-up.

Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a systematic review of propensity score-matched studies

“…Ratti et al showed that laparoscopic LND could result in a similar number of LN to open surgery with lower complications incidence related to LND. According to the guidelines, LND was acknowledged as a standard treatment for ICCA; those conflicting published results suggested that LLR for ICCA currently may not be totally optimal [ 16 , 19 , 34 ].…”

Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

“…MWA can be also combined with other locoregional therapies such as trans-arterial conventional chemoembolization, as was shown in a retrospective study which reported survival at 6, 12 and 24 months of 88.5%, 69.2% and 61.5%, respectively [48]. Furthermore, stereotactic navigation systems contribute to shortening the duration of ablation sessions by increasing the accuracy of access, even in challenging anatomic locations of the liver or for tumors located in proximity to important vasculature as well as for tumors invisible on ultrasound and CT [74,75]. Thermal ablative therapies (RFA and MWA) display promising potential as treatment modalities for iCCA with satisfactory outcome and good safety profile as was shown in published meta-analyses and systematic reviews [35,66,73] showing pooled technical efficacy of 91.9%, major complications incidence of 5.7% and pooled OS at 1, 3 and 5 years of 82.4%, 42.1% and 28.5%, respectively, with primary tumors showing higher 3-year OS rates than recurrent ones [66].…”

Locoregional Therapy for Intrahepatic Cholangiocarcinoma

“…Studies examined in this review used MWA for primary unresectable ICC, recurrent ICC after SR, and in the case of larger tumors, with palliative intent ( Table 2 ). Many studies included only patients with a largest tumor size of <5 cm and <3 lesions, though some studies included patients with larger tumors, up to 10 cm [ 25 , 26 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Most eligible patients were required to have sufficient coagulation parameters, platelet count, liver and kidney function, and adequate performance status [ 25 , 33 , 34 , 36 , 39 , 40 , 42 , 43 , 44 ].…”

“…Like RFA, studies have shown that MWA is well-tolerated in the treatment of ICC. Major complications ranged from 0–20% in examined studies and consisted of liver abscess, pleural effusion, ascites, hepatic failure, and tumor seeding [ 25 , 26 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Minor complications were common and included post-ablation syndrome, thrombocytopenia, a transient elevation in liver function tests (LFTs), and portal vein thrombosis [ 25 , 39 , 42 , 44 ].…”

“…Survival data varied widely between studies, likely due to the variable patient populations included in each study. Of studies examined in this review, the median OS of ICC patients treated with MWA ranged from 8.8–31.5 months, and median progression-free survival (PFS) ranged from 6.2–18.43 months [ 25 , 26 , 33 , 35 , 36 , 40 , 41 , 42 , 43 , 44 ]. Interestingly, the study by Yan et al assessed the impact of combining thermal ablative therapy, consisting of RFA or MWA, with systemic chemotherapy, compared to chemotherapy alone in the treatment of unresectable and previously untreated ICC.…”