Original PaperTransarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma
Introduction
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy after hepatocellular carcinoma (10 versus 90%, respectively), and has an increasing global incidence and mortality.1, 2, 3, 4 Surgical resection currently represents the only form of curative therapy; however, the majority of ICC patients are not surgical candidates due to their advanced disease at the time of diagnosis.3, 4, 5, 6 Due to a late diagnosis, untreated ICC results in rapid death.7
Most patients with ICC qualify for palliative therapy, including systemic chemotherapy and radiation therapy. However, such options have been regarded as affording little or no improvement in patient survival over supportive therapy alone, as ICC respond poorly to such existing therapies.8, 9, 10
Transarterial chemoembolization (TACE) has recently shown promising results for the palliative treatment of patients with unresectable ICC.7, 8, 9, 11 Compared with systemic chemotherapy, TACE has the advantages of increasing the local concentration of the chemotherapeutic agents used to kill cancer cells as well as reducing systemic side effects.12 Given that ICC arises within the intrahepatic biliary tree and that the arterial supply of the biliary tree arises from branches of the hepatic artery, TACE is believed to offer a new and effective therapeutic option for patients with unresectable ICC.7, 8, 11
Unfortunately, previous studies describing TACE for unresectable ICC had only a small number of patients (n < 50).7, 8, 9, 11 In addition, there was also the need for further study to compare the clinical outcome and survival benefit of TACE and supportive therapy alone in the palliative treatment of unresectable ICC. The purpose of the current study was to assess the clinical outcome and the survival benefits of TACE for unresectable ICC compared with those of supportive therapy.
Section snippets
Patient population
The current study was approved by our institutional review board to conduct a retrospective review of patients’ medical and imaging records. The inclusion criteria included histologically proven ICC that could not be treated with curative surgery, and sufficient bone marrow and organ function, e.g., absolute neutrophil count ≥2000/μl, platelet count ≥100,000/μl, and serum creatinine ≤1.5 mg/dl. The exclusion criteria included histologically proven extrahepatic cholangiocarcinoma or Klatskin
Patient characteristics
The baseline patient and tumour characteristics were well-balanced in the two groups (Table 1). Fifty-four percent (39/72) of the patients in the TACE group and 60% (50/83) of the patients in the supportive treatment group had extrahepatic metastasis.
Adverse event and tumour response after TACE
The median number of treatment sessions was 2.5 per patient (range 1–17 sessions). The incidence of more than grade 3 toxicity, as indicated by the Common Terminology Criteria v3.0, is presented in Table 2. Eleven haematological toxicity events
Discussion
Cholangiocarcinomas are neoplasms with biliary epithelial cell differentiation; ICC arise within the liver and extrahepatic cholangiocarcinomas originate in the bile duct along the hepatoduodenal ligament.11, 24 ICC usually presents as advanced disease at the time of diagnosis, because of the lack of symptoms until late in disease progression, and the overall prognosis is far worse than that of extrahepatic cholangiocarcinoma.8, 11, 25 Systemic chemotherapy and radiation therapy have been used
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