Endoscopic radiofrequency ablation plus a novel oral 5-fluorouracil compound versus radiofrequency ablation alone for unresectable extrahepatic cholangiocarcinoma

Yang, Jianfeng; Wang, Jing; Zhou, Haibin; Wang, Yucheng; Huang, Haitao; Jin, Hangbin; Lou, Qifeng; Zhang, Xiaofeng

doi:10.1016/j.gie.2020.04.075

Cited by 44 publications

(58 citation statements)

References 26 publications

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“…It is nonetheless questionable whether these promising results are transferable into a real-world setting since Bismuth type III and IV PHC, severe liver dysfunction, and systemic chemotherapy were exclusion criteria. Interestingly, the same group recently published a prospective RCT [35] that evaluated the clinical efficacy and safety of intraductal RFA in combination ( n = 37) with a novel oral 5-fluorouracil compound (S-1) versus intraductal RFA alone ( n = 38) for the treatment of unresectable locally advanced eCCA (70% distal CCA). While the incidence of ERCP-related adverse events did not differ significantly, the median overall survival (16 vs. 11 months, p < 0.001) as well as the stent patency time (6.6 vs. 5.6 months, p = 0.014) was significantly longer in the combination group.…”

Section: Efficacy and Safety Of Intraductal Rfa For Phcmentioning

confidence: 99%

Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma

Weismüller¹

2021

Visc Med

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Background: Patients with irresectable perihilar cholangiocarcinoma (PHC) have a limited prognosis with median survival times still less than 1 year. In addition to the current standard first-line systemic chemotherapy (gemcitabine and a platinum derivate), endoscopic treatment aims to ensure adequate drainage of the biliary system by placing biliary plastic or metal stents. Local ablative procedures like intraluminal biliary brachytherapy (ILBT) or photodynamic therapy (PDT) are used to improve local tumor control and to optimize the stent patency. Summary: Intraductal radiofrequency ablation (RFA) is another promising tool in the therapeutic armamentarium for the endoscopic management and tumor ablation of extrahepatic cholangiocarcinoma (eCCA). By applying thermal energy to the tissue through high-frequency alternating current, RFA induces coagulative necrosis and causes local destruction of the tumor. It is established as a first line percutaneous treatment of solid liver tumors, and since 2011 an endoscopic catheter is available that allows intraductal RFA in the biliary or pancreatic ducts. While the first pilot studies primarily evaluated this new method in patients with distal eCCA, there is now evidence accumulating also for PHC. Two retrospective and two prospective studies demonstrated a significantly improved overall survival and a longer stent patency with intraductal RFA, which overall had a favorable safety profile and was not associated with a significant increase in adverse events. However, prospective studies comparing the efficacy and safety of intraductal RFA, PDT, and/or ILBT are lacking. Key Messages: Recent studies suggest that intraductal RFA is an effective and well-tolerated additional treatment option with regard to stent patency but also overall survival. Since RFA has fewer systemic side effects and requires less logistical effort when compared to ILBT and PDT, intraductal RFA should be considered as another safe and feasible adjuvant method for the palliative care of patients with advanced PHC. Since comparative studies are lacking, the choice of the local ablative method remains in each case an individual decision.

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Section: Efficacy and Safety Of Intraductal Rfa For Phcmentioning

confidence: 99%

Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma

Weismüller¹

2021

Visc Med

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“…Over the past decade, many studies have validated the technical safety and effectiveness of ID-RFA (Table 1). [14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33] Most studies used the Habib RFA catheter, and various biliary stents were placed to maintain biliary drainage after ID-RFA. Alis et al 24 reported that endobiliary RFA therapy is feasible and safe for palliative treatment of distal and bismuth type I hilar extrahepatic cholangiocarcinoma.…”

Section: Clinical Efficacy Of Id-rfamentioning

confidence: 99%

“…Considering the local effect of ID-RFA, an enhanced therapeutic outcome can be anticipated when ID-RFA is combined with anticancer treatment, which is the current standard treatment for biliary cancer. A prospective randomised controlled study 32 reported that ID-RFA combined with S-1 for locally advanced extrahepatic cholangiocarcinoma was associated with longer survival and stent patency and improved functional status than RFA alone (16.0 months vs 11.0 months; P < 0.001 and 6.6 ± 1.5 months vs 5.6 ± 0.1 months; P = 0.014, respectively). Although S-1 is not the primary choice of anticancer agent for biliary tract cancer, it is necessary to evaluate the combined effects of various systemic anticancer therapies to improve the therapeutic outcomes of ID-RFA.…”

Section: Perihilar Application and Combination Therapy Of Id-rfamentioning

confidence: 99%

A review of the recent advances in endoscopic retrograde cholangiography-guided intraductal radiofrequency ablation for malignant biliary strictures

Young

Cho

Jang

et al. 2021

Int J Gastrointest Interv

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Pancreatobiliary malignancy is relatively rare; however, it remains one of the most lethal malignancies and has a dismal prognosis. Endoscopic retrograde cholangiopancreatography (ERCP)-guided intraductal radiofrequency ablation (ID-RFA) is a promising, minimally invasive treatment for unresectable malignant biliary strictures by delivering high-frequency alternating current to the target tissue, leading to coagulative necrosis. Recent studies have provided evidence that ERCP-guided ID-RFA is a safe, well-tolerated, and effective adjunctive treatment in terms of stent patency as well as overall survival. Compared with other local treatments, such as photodynamic therapy, ERCP-guided ID-RFA has advantages, including ease of delivery, controlled application of thermal energy, low cost, and fewer systemic side effects, with an acceptable safety profile. ERCP-guided ID-RFA has been proposed as an attractive endobiliary ablative therapy and is regarded to be an adjuvant method for the palliative care of patients with unresectable malignant biliary strictures. However, due to the ongoing lack of comparative studies, the choice of local ablative therapy remains, in each case, an individual decision by the multidisciplinary team.

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“…6 These milestones must be achieved before embarking upon a multidisciplinary approach to treatment. 7 Yang et al 8 compared mortality and other outcomes in a randomized trial of ERCP-guided intraductal radiofrequency ablation (RFA) with (n Z 37) and without (n Z 38) the use of a novel fluorouracil compound (S-1) for patients with unresectable extrahepatic CCA. Because all patients underwent intraductal RFA, the independent variable was the use of S-1.…”

Section: Editorialmentioning

confidence: 99%

The importance of the “endoscopic oncologist” in the treatment of nonoperable cholangiocarcinoma

Gaddam

Coté

2020

Gastrointestinal Endoscopy

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Endoscopic radiofrequency ablation plus a novel oral 5-fluorouracil compound versus radiofrequency ablation alone for unresectable extrahepatic cholangiocarcinoma

Cited by 44 publications

References 26 publications

Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma

Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma

A review of the recent advances in endoscopic retrograde cholangiography-guided intraductal radiofrequency ablation for malignant biliary strictures

The importance of the “endoscopic oncologist” in the treatment of nonoperable cholangiocarcinoma

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