Annals of Surgical Oncology

, Volume 18, Issue 2, pp 431–438

Precision Hepatic Arterial Irinotecan Therapy in the Treatment of Unresectable Intrahepatic Cholangiocellular Carcinoma: Optimal Tolerance and Prolonged Overall Survival

Authors

  • Suzanne C. Schiffman
    • Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer CenterUniversity of Louisville
  • Tiffany Metzger
    • Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer CenterUniversity of Louisville
  • Gregory Dubel
    • Division of Interventional Radiology, Department of Diagnostic ImagingWarren Alpert Medical School of Brown University and Rhode Island Hospital
  • Tomas Andrasina
    • Department of RadiologyFN Brno a LF MU
  • Ivan Kralj
    • DiakonissenkrankenhausKlinik für Radiologie, Interventionsradiologie und Nuklearmedizin
  • Cliff Tatum
    • Norton RadiologyNorton Healthcare
  • Kelly M. McMasters
    • Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer CenterUniversity of Louisville
  • Charles R. Scoggins
    • Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer CenterUniversity of Louisville
    • Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer CenterUniversity of Louisville
Hepatobiliary Tumors

DOI: 10.1245/s10434-010-1333-4

Cite this article as:
Schiffman, S.C., Metzger, T., Dubel, G. et al. Ann Surg Oncol (2011) 18: 431. doi:10.1245/s10434-010-1333-4

Abstract

Background

Unresectable intrahepatic cholangiocellular carcinoma (ICC) carries a poor prognosis, and there are few chemotherapeutic treatments to prolong survival. The purpose of this study was to assess the efficacy of drug-eluting bead (DEB) therapy by transarterial infusion for unresectable ICC.

Methods

A prospective multicenter study of ICC patients who received hepatic arterial DEB therapy.

Results

Twenty-four patients with unresectable ICC were treated with DEB. Ten patients (41.6%) had recurrent ICC after prior radiofrequency ablation (n = 3) or hepatectomy (n = 7). Twenty patients (80%) had received prior chemotherapy, mostly of gemcitabine (n = 8) or Eloxatin (n = 6). The percent of overall liver involvement was < 25% (n = 8), 26% to 50% (n = 11), and > 50% (n = 4). Ten patients (40%) had sites of extrahepatic disease located at lymph nodes (n = 5), bone (n = 2), peritoneum (n = 1), lung (n = 1), and mouth (n = 1). A total of 42 DEB treatments were administered. Eight were administered in combination with systemic chemotherapy of FOLFOX (n = 4) or Gemzar (n = 4). Twelve patients (48%) received a second treatment, and 4 patients (16%) received a third treatment. The median length of stay was 23 h (23–72 h). Eleven adverse reactions (26.2%) were reported. Of these, 7 (63.6%) were minor (less than grade 3). One patient died from hepatorenal syndrome. The disease of one patient was downstaged to resection. After a median follow-up of 13.6 months, the median overall survival of a multitherapeutic regimen with DEB therapy was significantly greater than chemotherapy alone (17.5 vs. 7.4 months; P = 0.02).

Conclusions

Bead therapy is safe and effective in patients with unresectable ICC. There is a marked survival benefit when DEB therapy is used as adjunctive therapy.

Copyright information

© Society of Surgical Oncology 2010