Unresectable intrahepatic cholangiocarcinoma: Systemic plus hepatic arterial infusion chemotherapy is associated with longer survival in comparison with systemic chemotherapy alone

Abstract

Background Intrahepatic cholangiocarcinoma (ICC) is associated with poor survival. This study compares the outcome of patients with unresectable ICC treated with hepatic arterial infusion (HAI) plus systemic chemotherapy (SYS) to SYS alone. Methods Consecutive patients with ICC were retrospectively reviewed. Clinicopathologic data were reviewed. Survival rates were compared by Kaplan-Meier analysis and log rank test. Results Between 1/2000 and 8/2012, 525 patients with ICC were evaluated at Memorial Sloan Kettering Cancer Center and 236 patients with unresectable tumors (locally advanced or metastatic) were analyzed. Disease was confined to the liver in 104 patients who underwent treatment with combined HAI and SYS (78, 75%) or SYS alone (26, 25%). The response rate in the combined group was better than in those who received SYS alone, although this did not reach statistical significance (59% vs 39%, respectively; p=0.11). Overall survival in the combined group was longer compared to patients who received SYS alone (30.8 months vs 18.4 months, respectively; p<0.001), and this difference was maintained when patients with portal lymph node disease were included in the survival analysis (HAI and SYS n=93 with survival 29.6 months vs SYS n=74 with survival 15.9 months, respectively; p<0.001). Eight patients who initially presented with unresectable tumors responded enough to undergo complete resection and had a median overall survival of 37 months (range=10.4 – 92.3 months). Conclusion In patients with unresectable ICC confined to the liver or with limited regional nodal disease, combined SYS and HAI chemotherapy is associated with greater survival compared to SYS alone.

The effect of preoperative chemotherapy treatment in surgically treated intrahepatic cholangiocarcinoma patients—A multi‐institutional analysis

“…In this study, we included 18 patients who received preoperative intra‐arterial chemotherapy, as opposed to the 44 patients who received systemic chemotherapy. Intra‐arterial therapy consists of the delivery of high doses of chemotherapy directly to the arterial circulation . This results in high first pass extraction rates and minimizes systemic toxicity, as tumors derive most of their supply from the arterial circulation .…”

“…Histologically, the majority of advanced ICC tumors are adenocarcinoma, which are typically treated with a combination of cytotoxic nucleoside analogs and platins . When feasible, complete surgical resection of ICC remains the only possible option for cure with an estimated median survival ranging from 27 to 36 months . However, only a minority of patients with ICC present with surgically resectable disease at the time of diagnosis.…”

Performance of prognostic scores and staging systems in predicting long‐term survival outcomes after surgery for intrahepatic cholangiocarcinoma

“…Complete surgical resection remains the only option for cure. The estimated median survival after resection of ICC ranges from 27 to 36 months . Postoperative survival estimates for individual patients can have consequences with regards to surveillance strategies and decisions about adjuvant chemotherapy …”

Robotic hepatic arterial infusion pump placement

“…8 A recent retrospective study that evaluated the role of added HAIP therapy in the treatment of unresectable intrahepatic cholangiocarcinoma revealed a statistically significant improvement in OS among 78 patients treated with HAIP and systemic therapy compared to 26 patients who underwent systemic therapy alone (30.8 months vs. 18.4 months; p < 0.001). 9 …”