Efficacy of Endobiliary Radiofrequency Ablation in Preserving Survival, Performance Status and Chemotherapy Eligibility of Patients with Unresectable Distal Cholangiocarcinoma: A Case-Control Study

Abstract

Background: Cholangiocarcinoma is the most common malignancy of the bile ducts causing intrahepatic, hilar, or distal bile duct obstruction. Most jaundiced patients are diagnosed with unresectable tumors in need for palliative bile duct drainage and chemotherapy. Endobiliary radiofrequency ablation (RFA) is an adjuvant technique that may be applied prior to biliary stenting. The aim of our study was to assess the efficacy of endobiliary RFA prior to stent insertion in patients with unresectable distal cholangiocarcinomas. Methods: Twenty-five patients (eight treated with RFA and stenting and 17 treated with stenting alone) were included in a case-controlled study. We prospectively assessed the impact of RFA on the survival rate, the patient performance status, and the preservation of eligibility for chemotherapy based on the patient laboratory profile. Results: Patients treated with RFA prior to stenting proved to have a significantly longer survival interval (19 vs. 16 months, p = 0.04, 95% CI) and significantly better performance status. Moreover, the laboratory profiles of patients treated with RFA has been proven superior in terms of total bilirubin, liver enzymes, and kidney function, thus making patients likely eligible for palliative chemotherapy. Post-ERCP adverse events were scarce in both the study group and the control group. Conclusion: Given the isolated adverse events and the impact on the patient survival, performance, and laboratory profile, RFA can be considered safe and efficient in the management of patients with unresectable distal cholangiocarcinomas.

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

“…A recent RCT included 25 patients with histologically confirmed unresectable distal cholangiocarcinoma, and randomly divided them into the RFA group (n = 8) and the control group (n = 17). The results showed that patients who received intraductal RFA had prolonged average OS (19 months vs 16 months, P = 0.04), improved quality of life, and more significantly improved liver and kidney functions 31 . Recent meta‐analyses have also suggested that compared to stenting alone, endobiliary RFA combined with stent implantation can prolong patient survival and stent patency in MBS without increasing the incidence of adverse events 32–35 .…”

Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis

“…19 Metallic stents were inserted in five studies 20,[22][23][24]26 and plastic stents were inserted in six. [16][17][18][19]21,25 All the studies recorded survival time, in different forms, but the duration of stent patency was recorded in only seven of the studies. [16][17][18][19][20][21]26 Adverse events were recorded in nine studies.…”

“…After removing duplicates and irrelevant studies, 63 studies remained for the assessment of their full text for eligibility. Ultimately, 11 studies (4 RCTs [16][17][18][19] and 7 OSs [20][21][22][23][24][25][26] ) were found to be eligible for qualitative synthesis. The flow diagram of the selection process is shown in Figure 1.…”

“…[16][17][18][19][20][21]26 Adverse events were recorded in nine studies. [16][17][18][19][22][23][24][25][26] The detailed baseline characteristics of the participants are presented in Tables 1 and 2.…”

A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada

“…Tumour progression can lead to decreased stent patency requiring stent replacement [ 81 ]. Several studies have shown prolonged stent patency with the use of local therapies, including intraluminal brachytherapy and radiofrequency ablation (both with and without chemotherapy), leading to improved outcomes in patients [ 82 , 83 , 84 , 85 ].…”