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

  • Suzanne C. Schiffman
  • Tiffany Metzger
  • Gregory Dubel
  • Tomas Andrasina
  • Ivan Kralj
  • Cliff Tatum
  • Kelly M. McMasters
  • Charles R. Scoggins
  • Robert C. G. Martin
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

Authors and Affiliations

  • Suzanne C. Schiffman
    • 1
  • Tiffany Metzger
    • 1
  • Gregory Dubel
    • 2
  • Tomas Andrasina
    • 3
  • Ivan Kralj
    • 4
  • Cliff Tatum
    • 5
  • Kelly M. McMasters
    • 1
  • Charles R. Scoggins
    • 1
  • Robert C. G. Martin
    • 1
  1. 1.Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer CenterUniversity of LouisvilleLouisvilleUSA
  2. 2.Division of Interventional Radiology, Department of Diagnostic ImagingWarren Alpert Medical School of Brown University and Rhode Island HospitalProvidenceUSA
  3. 3.Department of RadiologyFN Brno a LF MUBrnoCzech Republic
  4. 4.DiakonissenkrankenhausKlinik für Radiologie, Interventionsradiologie und NuklearmedizinKarlsruheGermany
  5. 5.Norton RadiologyNorton HealthcareLouisvilleUSA