Abstract. Aim: To report clinical outcomes of transarterial chemoembolization (TACE) using drug-eluting beads (DEBs) loaded with doxorubicin for the treatment of unresectable intrahepatic cholangiocarcinoma (CCA). Patients and Methods: We treated 127 patients with doxorubicin via TACE. Inclusion criteria were: diagnosis of unresectable CCA; indication for TACE, performance status (PS) 0-2, >3 months of life expectancy, >18 years old, written consent. TACE was performed using DEBs for 109 (86%) patients and polythylene glycol drug-elutable microspheres (PEG) loaded with doxorubicin for 18 (14%) patients. Results: Tumor response of the whole sample of 127 patients was partial response (PR) in 19 (15%) patients, stable disease (SD) in 101 (80%) and progressive disease (PD) in seven (5%) 3 months after therapy, with no complete responses.There were differences between type of embolics: PR was 7% and 77%, SD was 88% and 8%, and PD was 5% and 15%, and the disease control rate was 95% and 85% in the DEB and PEG groups, respectively. Most frequent side-effects were: abdominal pain, fever, nausea, and transaminase rise.
Conclusion: TACE was effective and safe for CCA treatment, with a high disease control rate. The best response of PEG-TACE was PR, whereas it was SD for DEB-TACE.About 10% of primary hepatic cancer is represented by cholangiocarcinoma (CCA), with a preferential distribution among men rather than women (1). CCA classification includes intrahepatic, perihilar and distal extrahepatic cancer (galbladder or coledocus). These groups have different biological characteristics, clinical diagnoses, and treatment management (2).Known risk factors for CCA include chronic inflammation, and injury of the bile tract, biliary lithiasis, and other novel risk factors such as obesity and hepatitis C virus infection (3). Over the past decades, CCA incidence and mortality has been increasing in Europe (4).Surgery is considered the only curative option for CCA, however, it is possible only for 27-30% of patients (5). Unresectable CCA has a poor prognosis, with a median survival of 3-6 months (6, 7). Systemic chemotherapy aims to reduce tumor growth and symptoms, and to improve the quality of life of patients with unresectable CCA, however, its benefits are poor, leading to an overall survival of about 1 year (8, 9). The combination of systemic chemotherapy with capecitabine and intra-arterial administration of toxic drugs is increasingly being used (10-12).Transarterial chemoembolization (TACE) allows the delivery of high concentration of chemotherapy selectively to the liver, in association with the embolization of the arteries afferent to the tumor (13-18). This method is achieving encouraging results in patients with CCA. Several studies with TACE for the therapy of unresectable CCA include mixed intrahepatic and extrahepatic CCA populations of only a small number of patients, for this reason it is difficult to have clear results on its efficacy. The purpose of this study was to report clinical outcomes of treatments of ...