Authors: Niraj J Gusani Fady K Balaa Jennifer L Steel David A Geller J Wallis Marsh Albert B Zajko Brian I Carr T Clark Gamblin
Publish Date: 2007/09/11
Volume: 12, Issue: 1, Pages: 129-137
Abstract
Survival for patients with unresectable cholangiocarcinoma is reported to range from only 5–8 months without treatment Systemic chemotherapy has not been shown to significantly improve survival but newer regimens involving gemcitabine have shown increased response rates Transcatheter arterial chemoembolization TACE has been shown to prolong survival in hepatocellular carcinoma patients but experience using TACE in the treatment of cholangiocarcinoma is limited We report our experience treating cholangiocarcinoma with TACE using chemotherapeutic regimens based on the welltolerated drug gemcitabineFortytwo patients with unresectable cholangiocarcinoma were treated with one or more cycles of gemcitabinebased TACE at our institution Chemotherapy regimens used for TACE included gemcitabine only n = 18 gemcitabine followed by cisplatin n = 2 gemcitabine followed by oxaliplatin n = 4 gemcitabine and cisplatin in combination n = 14 and gemcitabine and cisplatin followed by oxaliplatin n = 4Patients were 59 years of age range 36–86 and received a median of 35 TACE treatments range 1–16 Thirtyseven patients 88 had central cholangiocarcinoma and five 12 had peripheral tumors Nineteen patients 45 had extrahepatic disease Grade 3 adverse events AEs after TACE treatments were seen in five patients whereas grade 4 AEs occurred in two patients No patients died within 30 days of TACE Median survival from time of first treatment was 91 months overall Results did not vary by patient age sex size of largest initial tumor or by the presence of extrahepatic disease Treatment with gemcitabine–cisplatin combination TACE resulted in significantly longer survival 138 months compared to TACE with gemcitabine alone 63 monthsOur report represents the largest series to date regarding hepaticarterydirected therapy for unresectable cholangiocarcinoma and provides evidence in favor of TACE as a promising treatment modality in unresectable cholangiocarcinoma Our results suggest that gemcitabinebased TACE is well tolerated and confers better survival when given in combination therapy with cisplatin or oxaliplatin for patients with unresectable cholangiocarcinoma
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