Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Vogl, Thomas J.; Naguib, N; Nour-Eldin, Nour-Eldin A.; Bechstein, Wolf O.; Zeuzem, Stefan; Trojan, Jörg; Gruber‐Rouh, Tatjana

doi:10.1002/ijc.26407

Cited by 125 publications

(75 citation statements)

References 49 publications

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“…148 A similar median survival was demonstrated with mitomycin C (11 months), comparable to the survival of patients with positive LN or positive surgical margins. 149 Treatment of unresectable ICC with doxorubicineluting beads has shown 100% tumor response rate and median survival of 13 months.…”

Section: Hepatic Artery-based Therapiessupporting

confidence: 58%

Comprehensive management of cholangiocarcinoma: Part II. Treatment

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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Cholangioarcinoma is a rare but dreadful malignancy which poses much difficulties in the management. If detected early with only localized disease, curative resection is possible. However, most patients present in the late stages of the disease, which are managed with endoscopic biliary drainage and/or chemoradiation. Liver transplantation offers a possibility for cure in the distal and the perihilar tumors for selected candidates. Local treatments, such as hepatic artery-based therapies, brachytherapy, and photodynamic therapy, may offer some benefit in cases of the advanced disease. In this review, we will assess the role of preoperative biliary drainage, how best to drain biliary obstruction, and the intricate details of various treatments that are currently available. Management of Cholangiocarcinoma Preoperative biliary drainagePreoperative biliary drainage (PBD) is achieved with endoscopic or percutaneous approach. The topic is controversial and the review of the literature revealed conflicting results. PBD of the future remnant hepatic lobe is supposed to decrease hepatic dysfunction and liver failure postoperatively.1 The meta-analysis found no difference in mortality between patients with and without PBD and the authors advised that such procedure should not be performed routinely.2 Another meta-analysis of almost 5,000 patients with distal obstruction (425 with distal cholangiocarcinoma [DCC]) did not find any evidence that PBD (without distinguishing between endoscopic or percutaneous approach) increases morbidity or mortality. However it was associated with significant bacterial infection of the bile and possibly adverse outcomes after surgery.3 Other studies showed that PBD reduced jaundice, which positively affected outcomes, but not survival, and that it might be associated with more intraoperative blood loss, but less reoperation rates compared to non-drained cases. 4,5 The prospective randomized study of almost 200 patients with cancer of the head of the pancreas demonstrated that PBD was associated with more non-surgical adverse events compared to those managed only with surgery (46% vs 2%, respectively). Surgical adverse events were also more in the PBD group (47% vs 37%). The high incidence of cholangitis in those treated with PBD may be associated with the long lag time between PBD and surgery (5 weeks) and the high occlusion rate of plastic stents (PSs) (15%), prompting other authors to suggest that use of short, self-expandable metal stents (SEMS) may result in better outcomes for distal bile duct strictures. In accordance with other studies, there was no effect of PBD on mortality.6,7 In perihilar cholangiocarcinoma (PCC), the systematic review of 700 patients with and without PBD suggested that there is higher incidence of postoperative infections (18%-52% vs 0%-27%) and overall adverse events (36%-100% vs 29%-72%) in the PBD compared to the non-PBD group. There was no difference in mortality in the two groups. 8 Other studies favor the use of PBD in the preoperative management of PCC. ...

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Section: Hepatic Artery-based Therapiessupporting

confidence: 58%

Comprehensive management of cholangiocarcinoma: Part II. Treatment

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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“…The median OS was 13 months from initial embolization and no statistically significant differences were observed between regimens (18). A smaller study included 17 patients with unresectable ICC, who underwent a median of two cTACE sessions per patient.…”

Section: A B Cmentioning

confidence: 98%

“…Generally, TACE is tolerated well by the majority of patients without major adverse events. However, abdominal pain, nausea, fever and increase in liver enzymes (limited to 3-4 days without the evidence of sepsis) are frequent transient minor side effects after cTACE procedures and commonly referred to as post-embolization syndrome (16)(17)(18).…”

Section: Ctace-backgroundmentioning

confidence: 99%

Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects

Savic¹,

Chapiro²,

Geschwind³

2017

Hepatobiliary Surg. Nutr.

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Intrahepatic cholangiocarcinoma (ICC) is a rare disease and carries a poor prognosis with surgery remaining the only curative treatment option. However, due to the late presentation of symptoms and close proximity of the tumors to central hepatic structures, only about 30% of patients are classified eligible to resection. As for palliative approaches, ICC constitutes a possible indication for loco-regional therapies (LRT). As such, intra-arterial therapies (IAT) are reported to be feasible, safe and effective in inducing tumor response in unresectable ICC. The paradigm of IAT is premised on the selective delivery of embolic, chemotherapeutic agents to the tumor via its feeding arteries, thus allowing dose escalation within the carcinoma and reduction of systemic toxicity. Conventional transcatheter arterial chemoembolization (cTACE) so far remains the most commonly used IAT modality. However, drug-eluting beads (DEB)-TACE was initiated with the idea of more selective targeting of the tumor owing to the combined embolizing as well as drug-eluting properties of the microspheres used in this setting. Moreover, radioembolization is performed by intra-arterial administration of very small spheres containing β-emitting yttrium-90 (Y90-RE) to the site of the tumor. Clinical evidence exists in support of survival benefits for IAT in the palliative treatment of ICC compared to surgery and systemic chemotherapy. As for combination regimens, cTACE, DEB-TACE and Y90-RE are reported to achieve conversion of patients to surgery in a sequential treatment planning and simultaneous IAT combinations may provide a therapeutic option for treatment escalation. Regarding the current status of literature, controlled randomized prospective trials to compare different IAT techniques and combination therapies as well as treatment recommendations for different IAT modalities are needed.

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“…The overall survival was still less than 1 year (2). Several trials on the effects of transarterial chemoembolization (TACE) also showed a wide range of the relatively short median survival from 12.2-15 months (3)(4)(5). Recently, chemoembolization with drug-eluting beads-TACE was investigated, but the median overall survival was also short -11.7 months (6).…”

Section: Introductionmentioning

confidence: 99%