Transarterial Chemoembolization (TACE) for Inoperable Intrahepatic Cholangiocarcinoma

Abstract

The aim of this retrospective study was to determine the safety and efficacy of chemoembolization (TACE) as palliative treatment for patients with unresectable intrahepatic cholangiocarcinoma (CCA) and to compare the results with those in the literature. Fifteen patients with histology-proven CCA (5 men, 10 women) had received palliative treatment with TACE over a 6-year period. The treatment protocol comprised repeated TACE at a minimum of 8-week intervals. TACE was performed with a mixture of 10 ml Lipiodol and 10 mg mitomycin C injected into the tumor-supplying vessels. Follow-up investigations after 8-10 weeks comprised contrast-enhanced multislice spiral CT and laboratory control. Statistical evaluation included survival analysis using the Kaplan-Meier method. During the investigation period 58 TACEs (3.9 +/- 3.8; 1-15) were performed in 15 patients. Mean tumor size was 10.8 +/- 4.6 cm (range, 2.0-18.0 cm). Unifocal tumor disease was diagnosed in eight patients, and multifocal disease in seven. Mean survival was 21.1 months (95% CI, 9.4-32.5 months). At the end of the investigation period 3 patients are still alive, and 12 patients have died. The 1-, 2-, and 3-year survival rate was 51.3%, 27.5%, and 27.5% respectively. According to RECIST criteria interim best response to therapy was stable disease in 9 of 15 patients, a partial response in 1 of 15 patients, and tumor progression in 4 of 15 patients. No deaths and no acute liver failure occurred under TACE therapy. Major complications were observed in two patients, comprising anaphylactic shock owing to contrast medium administration in one and gastric ulceration due to lipiodol displacement in the second patient. These results demonstrate that TACE is a safe procedure with a moderate number of complications for patients suffering from inoperable CCA. According to recently published data on i.v. chemotherapy we suggest that TACE might be able to prolong survival in selected patients who would succumb under other palliative treatment modalities.

Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma

“…However, as the arterial supply of the biliary tree arises from branches of the hepatic artery, it may be possible to target ICC much more selectively using TACE or TACI than with systemic chemotherapy. 2,23 In our multivariate analysis, tumor vascularity (OR, 31.2; P 5 .002) was the only significant factor associated with clinical success after hepatic intraarterial chemotherapy for treating ICC. This indicates that ICC with a larger arterial supply may have a greater chance of tumor response with TACE than ICC with a decreased arterial supply, because a chemotherapeutic agent or embolic material can be much more effectively and selectively delivered after TACE.…”

“…[18][19][20][21][22] Given that ICC arises within the intrahepatic biliary tree, hepatic intra-arterial chemotherapy was believed to offer a new effective treatment for patients with unresectable ICC. 2 To our knowledge, there have been only a few studies 2,23 reporting the efficacy of TACE for ICC; however, these studies 2,23 have had the disadvantage of small study populations, ie, usually fewer than 20 patients. In addition, there is a need for further study of the influence of the prognostic factors associated with clinical outcome and survival.…”

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

“…[39][40][41][42] Previous studies showed that TACE is an effective alternative treatment and recommended therapy for unresectable CCC with positive effects on the tumor-associated symptoms. 23,[44][45][46] In the current study, 115 patients with unresectable CCC were repeatedly treated with TACE. We achieved median and mean survival time of 13 and 20.8 months from the start of TACE, and the survival rate was 52% at 1 year, 29% at 2 years and 10% at 3 years.…”

“…In other studies, distant metastases were exclusion criteria for study. 23,45 The current study has several limitations. First, the study design was nonrandomized.…”

“…This difference in the survival is probably attributed to the differences in patient selection and tumor load. In the study of Herber et al, 45 15 patients with inoperable CCC received TACE using a mixture of Lipiodol and Mitomycin C with a minimum interval of 8 weeks between procedures. The mean survival time was 21.1 months.…”