Endobiliary Radiofrequency Ablation Combined with Gemcitabine and Cisplatin in Patients with Unresectable Extrahepatic Cholangiocarcinoma

Abstract

Background: Endobiliary radiofrequency ablation (RFA) is a promising treatment modality for patients with extrahepatic cholangiocarcinoma (eCCA). However, no study has investigated the combined use of endobiliary RFA and gemcitabine plus cisplatin (GC) chemotherapy. This study aimed to examine the feasibility and efficacy of endobiliary RFA with GC therapy for patients with unresectable eCCA. Methods: The study outcomes included overall survival (OS), progression-free survival (PFS), time to recurrent biliary obstruction (RBO), and adverse events associated with the treatment. These parameters were retrospectively compared between 25 patients who underwent RFA with self-expandable metal stent (SEMS) placement followed by GC therapy (with-RFA group) and a control cohort of 25 patients who underwent SEMS placement alone and GC therapy (without-RFA group). Results: The median time to RBO was significantly longer in the with-RFA group (10.7 versus 5.2 months, p = 0.048). The median OS was significantly higher in patients with locally advanced tumors in the with-RFA group (23.1 versus 16.6 months, p = 0.032), but did not differ significantly in patients with metastasis (11.4 versus 8.5 months, p = 0.180). Similarly, the median PFS was significantly higher in the with-RFA group in patients with locally advanced disease (10.1 versus 7.3 months, p = 0.015), while there was no significant difference in patients with metastasis (5.4 versus 4.4 months, p = 0.529). The rates of various toxicities did not differ significantly between the groups. Conclusions: Endobiliary RFA prolonged the patency period of uncovered SEMS combined with GC therapy in patients with eCCA. Although RFA also yielded survival benefits, its effect was restricted to locally advanced tumors.

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

“…RFA works by promoting coagulation necrosis on the targeted area and, consequently, local control of tumor growth [8]. Given the mechanisms of intraductal RFA, research has been undertaken to determine whether RFA could not only improve survival, but also prolongs stent patency rates [9][10][11][12][13]. Despite an increased adoption of intraductal RFA in advanced endoscopy practice, typically limited to high-volume or tertiary centers, there is a paucity of data and guidelines to suggest its use.…”

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

“…Traditionally, the supporting data for biliary RFA therapy have been driven by retrospective studies that showed the potential efficiency and safety of RFA when added to standard stenting [ 14 , 15 ]. To date, RFA has gained momentum, and there are several randomized and prospective trials showing that endobiliary RFA prior to stent placement or at the time of stent occlusion might be efficient and safe in prolonging stent patency or even life expectancy [ 16 , 17 , 18 , 19 ]. Moreover, a relatively recent meta-analysis showed that when added to stent placement RFA increases both survival and stent patency compared to stent placement alone [ 20 ].…”

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

“…Multiple studies have shown that endobiliary RFA is safe and effective for the treatment of MBS 8–28 . A prospective single‐center randomized controlled trial (RCT) involving 68 patients with unresectable extrahepatic cholangiocarcinoma demonstrated that endobiliary RFA combined with plastic stent implantation significantly prolonged overall survival (OS) (13.2 ± 0.6 months vs 8.3 ± 0.5 months, P < 0.001) and the median stent patency time (6.8 months vs 3.4 months, P = 0.02) compared with stenting alone.…”