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Transarterial Chemoembolization and Radioembolization for Unresectable Intrahepatic Cholangiocarcinoma—a Systemic Review and Meta-Analysis

CardioVascular and Interventional Radiology volume 44, pages 728–738 (2021)Cite this article

Abstract

Purpose

Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis, when unresectable; therefore, intra-arterial therapies (IAT) such as trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE) have been employed. With the present systematic review and meta-analysis, we aimed to analyse published studies to understand if one IAT can be superior to the alternative.

Materials and methods

A systematic search of PubMed and Web of Science databases was performed for articles published until 1 March 2020 relevant to IAT for ICC. Overall survival was the primary end point. Occurrence of clinical adverse events and tumour overall response were secondary outcome measures.

Results

A total of 31 articles (of 793, n.1695 patients) were selected for data extraction, 13 were on TACE (906 patients) and 18 were on TARE (789 patients). Clinical and tumour characteristics showed moderate heterogeneity between the two groups. The median survival after TACE was 14.2 months while after TARE was 13.5 months (95%C.I.: 11.4–16.1). The survival difference was small (d = 0.112) at 1 year and negligible at 2 years (d = 0.028) and at 3 years (d = 0.049). The radiological objective response after TACE was 20.6% and after TARE was 19.3% (d = 0.032). Clinical adverse events occurred in 58.5% after TACE, more frequently than after TARE (43.0%, d = 0.314).

Conclusion

In conclusion, IATs are promising treatments for improving outcomes for patients with unresectable ICC. To date, TACE and TARE provide similar good outcomes, except for adverse events. Therefore, the decision about techniques is determined by ability to utilize these resources and patient specific factors (liver function or lesion dimension).

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant’Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy

    Cristina Mosconi, Giulio Vara, Nicolò Brandi, Alberta Cappelli, Francesco Modestino & Rita Golfieri

  2. Department of Medical and Surgical Sciences–DIMEC, Alma Mater Studiorum – University of Bologna, Bologna, Italy

    Leonardo Solaini & Alessandro Cucchetti

  3. Department of Surgery, Morgagni – Pierantoni Hospital, Forlì, Italy

    Leonardo Solaini & Alessandro Cucchetti

  4. Department of Specialized, Diagnostic and Experimental Medicine – DIMES, Alma Mater Studiorum - University of Bologna, Bologna, Italy

    Rita Golfieri

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  1. Cristina Mosconi
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  2. Leonardo Solaini
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  3. Giulio Vara
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  4. Nicolò Brandi
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Correspondence to Cristina Mosconi.

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Alessandro Cucchetti and Rita Golfieri share the senior authorship.

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Mosconi, C., Solaini, L., Vara, G. et al. Transarterial Chemoembolization and Radioembolization for Unresectable Intrahepatic Cholangiocarcinoma—a Systemic Review and Meta-Analysis. Cardiovasc Intervent Radiol 44, 728–738 (2021). https://doi.org/10.1007/s00270-021-02800-w

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Keywords

  • Intrahepatic cholangiocarcinoma
  • Intra-arterial therapies
  • Trans-arterial chemoembolization
  • Trans-arterial radioembolization