Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

Efficacy of microwave ablation for intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Background

Data on overall survival (OS) and progression-free survival (PFS) after microwave ablation (MWA) for intrahepatic cholangiocarcinoma (ICC) are scarce. We conducted a systematic review of the safety and efficacy of MWA for ICC.

Methods

The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting the outcomes of MWA for ICC. Meta-analyses of the pooled OS, PFS, technical success, technical efficacy, and complication rates were conducted. Pooled hazard ratios (HRs) of common variables were calculated to identify the factors associated with OS.

Results

The analysis encompassed 168 entries, among which 8 observational studies comprising 
423 patients were deemed eligible. The pooled results were as follows: The median OS was 22.0 months [95% confidence interval (CI): 15.1-28.9], with the 1-, 3-, and 5-year OS rates being 83.7% (95% CI: 
75.8-91.6%), 51.0% (95% CI: 41.1-60.9%), and 33.3% (95% CI: 14.1-52.4%), respectively. The median PFS was 12.5 months (95% CI: 8.3-16.7), and the 1-year PFS rate was 61.2% (95% CI: 36.5-85.9%). The technical success, technical efficacy, and major complication rates were 100% (95% CI: 99.5-100%), 99% (95% CI: 92.1-100%), and 2.8% (95% CI: 1.1-5.2%), respectively. A cancer antigen 19-9 (CA 19-9) level >37 U/mL was associated with a shorter OS (HR =1.4; 95% CI: 1.2-1.7; P=0.001).

Conclusions

MWA is a safe and effective alternative to chemotherapy, radiotherapy, and radiofrequency ablation (RFA) treatments, especially for patients with a CA 19-9 level ≤37 U/mL, and potentially has advantages over RFA. However, further studies are required to validate these findings.

Percutaneous liver-directed therapies of intrahepatic cholangiocarcinoma

Cholangiocarcinoma is a hepatobiliary malignancy which can manifest anywhere along the biliary tree. Intrahepatic cholangiocarcinoma occurs in the liver within or beyond the second order bile ducts. The prognosis for patients with intrahepatic cholangiocarcinoma is poor, even when successfully resected there is a very high rate of local recurrence. The available systemic therapies are currently limited and have high rates of toxicity. Percutaneous and transarterial liver-directed therapies can be used to treat intrahepatic cholangiocarcinoma with results comparable to current standard of care systemic therapies in some circumstances. This manuscript will review these the techniques and efficacy of percutaneous and transarterial liver-directed therapies for intrahepatic cholangiocarcinoma.

Interventional Radiology Locoregional Therapies for Intrahepatic Cholangiocarcinoma

Surgical resection remains the cornerstone of curative treatment for intrahepatic cholangiocarcinoma (iCCA), but this option is only available to a small percentage of patients. For patients with unresectable iCCA, systemic therapy with gemcitabine and platinum-based agents represents the mainstay of treatment; however, the armamentarium has grown to include targeted molecular therapies (e.g., FGFR2 inhibitors), use of adjuvant therapy, liver transplantation in select cases, immunotherapy, and locoregional liver-directed therapies. Despite advances, iCCA remains a challenge due to the advanced stage of many patients at diagnosis. Furthermore, given the improving options for systemic therapy and the fact that the majority of iCCA patients succumb to disease progression in the liver, the role of locoregional therapies has increased. This review will focus on the expanding role of interventional radiology and liver-directed therapies in the treatment of iCCA.