Initial experience from a combination of systemic and regional chemotherapy in the treatment of patients with nonresectable cholangiocellular carcinoma in the liver

Kirchhoff, Timm; Zender, Lars; Merkesdal, Sonja; Frericks, Bernd; Malek, Nisar P.; Bleck, Joerg S.; Kubicka, Stefan; Baus, Stefan; Chavan, Ajay; Manns, Michael P.; Galanski, Michael

doi:10.3748/wjg.v11.i8.1091

Cited by 30 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[39][40][41][42] Previous studies showed that TACE is an effective alternative treatment and recommended therapy for unresectable CCC with positive effects on the tumor-associated symptoms. 23,[44][45][46] In the current study, 115 patients with unresectable CCC were repeatedly treated with TACE. We achieved median and mean survival time of 13 and 20.8 months from the start of TACE, and the survival rate was 52% at 1 year, 29% at 2 years and 10% at 3 years.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Vogl

Naguib

Nour-Eldin

et al. 2011

Intl Journal of Cancer

126

View full text Add to dashboard Cite

The aim of the study was to evaluate the effectiveness of transarterial chemoembolization (TACE) with four chemotherapeutic protocols in terms of local tumor control and survival of patients with unresectable cholangiocarcinoma (CCC) and to identify the prognostic factors governing treatment success. In the single-centre study, 115 patients (mean ages 5 60.4 years) with unresectable CCC were repeatedly treated with TACE. In total, 819 chemoembolization sessions were performed in 4 week intervals with a mean of 7.1 (range, 3-30) sessions per patient. The chemotherapeutic used was Mitomycin C only in 20.9% of patients, Gemcitabine only in 7%, Mitomycin C with Gemcitabine in 47% and combination of Gemcitabine, Mitomycin C and Cisplatin in 25.1%. Local tumor response was evaluated by MRI according to RECIST. Survival data were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank-test. The local tumor controls were: partial response 8.7%, stable disease 57.4% and progressive disease 33.9% of patients. The median and mean survival times from the start of TACE were 13 and 20.8 months. Survival rate from the start of TACE was 52% after 1-year, 29% after 2-years and 10% after 3-years. Initial tumor response, high tumor vascularity and Child-Pugh class A were statistically significant factors for patient's survival. No statistically significant difference between patients treated with different chemotherapy protocols was noted. In conclusion, TACE is a palliative and safe treatment option for patients with unresectable CCC. Child Pugh class B, tumor hypovascularity and initially progressive disease were poor prognostic factors for patient survival.Cholangiocarcinoma (CCC) is the second most common primary hepatic malignancy following hepatocellular carcinoma. 1 The tumor represents less than 2-3% of all cancers and up to 19% of primary liver cancers worldwide. [1][2][3][4] In Europe and North America, the average incidence of CCC is 1-2/100,000 per year. 5,6 The incidence during the last years is increasing, and this increasing incidence is associated with an increase in mortality. 2,7-10 Because of an advanced nature of the tumor on the time of first diagnosis, the therapeutic options for patients with unresectable CCC are limited.Transarterial chemoembolization (TACE) is a local, catheter-based, minimally invasive therapeutic option for unresectable liver tumors, and is defined as a selective administration of chemotherapy usually combined with embolization of the vascular supply of the tumor. 11 For patients with liver tumors, TACE, as a combination of local-arterial application of chemotherapeutic drugs with additional usage of embolization particles, is an effective and recommended treatment. The concept of TACE has been used in the management of patients with liver metastases from colorectal cancer, breast carcinoma as well as patients with unresectable hepatocellular carcinoma (HCC). [12][13][14][15][16][17] Regarding unresectable CCC there are few...

show abstract

Section: Discussionmentioning

confidence: 99%

“…Eight patients in the study of Kirchhoff et al 44 received TACE using Cisplatin, doxorubicin and degradable starch microspheres with systemic infusion of Gemcitabine chemotherapy. In this study the median survival time for the whole group was 12 months, and the median time to tumor progression was 7 months.…”

Section: Cancer Therapymentioning

confidence: 99%

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Vogl

Naguib

Nour-Eldin

et al. 2011

Intl Journal of Cancer

126

View full text Add to dashboard Cite

show abstract

“…Although the drug concentration diminished with increased distance away from the implanted site, but 10 days after implantation, the drug concentration at 5 cm away from the implanted site was still higher than the lowest tumour-inhibiting concentration (0.05 μg/g) (Wang et al, 2012). The results also showed that there was a higher drug concentration in the portal vein 10 days after implantation (the lowest tumour-inhibiting concentration is 0.1 μg/g in the blood) (Kirchhoff et al, 2005), suggesting that it is of great importance for the prevention and treatment of liver metastasis. Besides, there was no visible necrosis at the local implanted tissue.…”

Section: Discussionmentioning

confidence: 62%

Experimental Study on Sustained-release 5-Fluorouracil Implantation in Canine Peritoneum and Para-aortic Abdominalis

Guo

Nie²,

Shen³

et al. 2014

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Objective: To observe local and systemic toxicity after sustained-release 5-fluorouracil (5-Fu) implantation in canine peritoneum and para-aortic abdominalis and the changes of drug concentration in the local implanted tissue with time. Methods: 300 mg sustained-release 5-Fu was implanted into canine peritoneum and para-aorta abdominalis. Samples were taken 3, 5, 7 and 10 days after implantation for assessment of changes and systemic reactions. High performance liquid chromatography was applied to detect the drug concentrations of peritoneal tissue at different distances from the implanted site, lymphatic tissue of para-aortic abdominalis, peripheral blood and portal venous blood. Results: 10 days after implantation, the drug concentrations in the peritoneum, lymphatic tissue and portal vein remained relatively high within 5 cm of the implanted site. There appeared inflammatory reaction in the local implanted tissue, but no visible pathological changes such as cell degeneration and necrosis, and systemic reaction like anorexia, nausea, vomiting and fever. Conclusions: Sustained-release 5-Fu implantation in canine peritoneum and para-aortic abdominalis can maintain a relatively high tumourinhibiting concentration for a longer time in the local implanted area and portal vein, and has mild local and systemic reactions. Besides, it is safe and effective to prevent or treat recurrence of gastrointestinal tumours and liver metastasis.

show abstract

“…Median time from the first percutaneous intervention to the successful implantation of metal stent was 44 days, and the average number of percutaneous sessions totalled 5.2 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). This depended on the favorable effect of percutaneous drainage (for at least 2 weeks, with substantial improvement of laboratory tests), of the technique and the necessary time for histological confirmation of malignant stenosis.…”

Section: Resultsmentioning

confidence: 99%

“…8 The combination of systemic chemotherapy (gemcitabine) and regional chemoembolizations may enhance the effect of palliation in a selected group of patients with a 21.1-23 months (1, 2, and 3-year survival rates 51.3%, 27.5%, and 27.5%, respectively) reported median of overall survival. [9][10][11] The potential benefit of regional chemotherapy with port system implanted percutaneously in intrahepatic cholangiocarcinoma (CC) was also reported by Tanaka et al 12 with a 26-month mean overall survival. All in all, intra-arterial therapies (chemoembolizations and chemoperfusions) offer a potential benefit and prolonged survival for patients with unresectable cholangiocarcinoma.…”

Section: Introductionmentioning

confidence: 89%

Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Andrašina¹,

Válek²,

Pánek³

et al. 2010

Gut Liver

View full text Add to dashboard Cite

Background/Aims: To prospectively evaluate our palliative management of unresectable cholangiocarcinoma (CC) treated with tailored multimodal oncological therapy. Methods: Between January 2005 and January 2010, 50 consecutive patients with unresectable CC and jaundice were palliated with percutaneous drainage. Forty-three patients underwent metallic-stent implantation followed by brachytherapy. Patients were divided into two arms: the intra-arterial chemotherapy arm (IA arm, n=17) consisted of patients treated with locoregional treatment (IA admission of Cisplatin and 5-fluorouracil, or chemoembolization with Lipiodol) and/or systemic chemotherapy, while the systemic chemotherapy arm (IV arm, n=23) included all the other patients, who were treated only with systemic chemotherapy. Results: In total, 78 metal self-expandable stents were placed. Hilar involvement with mass-forming and periductal infiltrating types of CC (84%) was predominant. The average number of percutaneous interventional procedures was 11.61 per patient (range, 4-35). The median overall survival from diagnosis of disease for all patients was 13.5 months (range, 11.0-18.8 months). The median overall survival times were 25.2 months (range, 15.2-31.3 months) and 11.5 months (range, 8.5-12.6 months) in the IA and IV arms, respectively (p＜0.05). The 1-, 2-, and 3-year survival rates in the IA and IV arms were 88.2%, 52.9%, and 10.1% and 43.5%, 25.4, and 0%, respectively. There were no major complications (WHO III/IV) due to interventional procedures. Conclusions: We could reach acceptable prognosis in patients with unresectable CC using complex tailored oncological therapy. However, the main limitations of prolonging survival are performance status, patient compliance and the maintaining of biliary tract patency. (Gut Liver 2010;4(Suppl. 1):S82-88)

show abstract

Initial experience from a combination of systemic and regional chemotherapy in the treatment of patients with nonresectable cholangiocellular carcinoma in the liver

Abstract: The present results indicate that a combination of systemic gemcitabine therapy and repeated regional chemoembolizations is well tolerated and may enhance the effect of palliation in a selected group of patients with intrahepatic nonresectable CCC.

Cited by 30 publications

References 21 publications

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

Experimental Study on Sustained-release 5-Fluorouracil Implantation in Canine Peritoneum and Para-aortic Abdominalis

Multimodal Oncological Therapy Comprising Stents, Brachytherapy, and Regional Chemotherapy for Cholangiocarcinoma

Contact Info

Product

Resources

About