Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects

Abstract

Intrahepatic cholangiocarcinoma (ICC) is a rare disease and carries a poor prognosis with surgery remaining the only curative treatment option. However, due to the late presentation of symptoms and close proximity of the tumors to central hepatic structures, only about 30% of patients are classified eligible to resection. As for palliative approaches, ICC constitutes a possible indication for loco-regional therapies (LRT). As such, intra-arterial therapies (IAT) are reported to be feasible, safe and effective in inducing tumor response in unresectable ICC. The paradigm of IAT is premised on the selective delivery of embolic, chemotherapeutic agents to the tumor via its feeding arteries, thus allowing dose escalation within the carcinoma and reduction of systemic toxicity. Conventional transcatheter arterial chemoembolization (cTACE) so far remains the most commonly used IAT modality. However, drug-eluting beads (DEB)-TACE was initiated with the idea of more selective targeting of the tumor owing to the combined embolizing as well as drug-eluting properties of the microspheres used in this setting. Moreover, radioembolization is performed by intra-arterial administration of very small spheres containing β-emitting yttrium-90 (Y90-RE) to the site of the tumor. Clinical evidence exists in support of survival benefits for IAT in the palliative treatment of ICC compared to surgery and systemic chemotherapy. As for combination regimens, cTACE, DEB-TACE and Y90-RE are reported to achieve conversion of patients to surgery in a sequential treatment planning and simultaneous IAT combinations may provide a therapeutic option for treatment escalation. Regarding the current status of literature, controlled randomized prospective trials to compare different IAT techniques and combination therapies as well as treatment recommendations for different IAT modalities are needed.

Treatment of Intrahepatic Cholangiocellular Carcinoma with Y-90 Labelled Microspheres

“…YİMT'nin neden olduğu en önemli yan etkilerden diğerleri de Radyoembolizasyon (RE) kaynaklı karaciğer hastalığı (REILD), ve radyasyona bağlı pnömonisidir. Radyoembolizasyon kaynaklı karaciğer hastalığı, tümör ilerlemesi veya safra kanalı tıkanıklığı yokluğunda RE'den 1 ila 2 ay sonra ortaya çıkan sarılık ve asit olarak tanımlanmıştır (17). Etkilenen hastalarda transaminaz seviyelerinde bir değişiklik olmadan ve bariz biliyerdilatasyon veya tümör progresyonu olmadan total bilirubin, alkalenfosfataz ve γ-glutamiltranspeptidaz seviyeleri artar (18).…”

“…Günümüzde YİMT için kullanılan iki ana taşıyıcı mevcuttur: Cam bazlı mikroküreler (TheraSphere, MDS, Nordion, Ottawa, Ontario, Kanada) ve reçine bazlı mikroküreler (SIRSphere, Sirtex, Yeni Güney Galler, Avustralya) (17) (22). Farklı çalışmalarda YİMT'yi takiben görülen yan etkiler raporlanmıştır.…”

“…Farklı çalışmalarda YİMT'yi takiben görülen yan etkiler raporlanmıştır. Yapılan bir çalışmaya göre en sık görülen yan etki halsizlik (%33), karın ağrısı (%28) ve bulantı (%25) idi (17). Standart kemoterapiye yanıtsız olan, nodüler ve infiltratif İKK'li 46 hastada, 92 tedavi içeren geniş bir prospektif seride cam mikroküreler kullanılmış olup soliter tümörlü hastalar için medyan sağkalım 14,3 aydı.…”

“…Tüm hastalarda işlemler iyi tolere edildi. Ancak karın ağrısı en sık bildirilen yan etkiydi ve hastaların %54'ünde mevcuttu (17).…”

Adjuvant transarterial chemoembolization following radical resection for intrahepatic cholangiocarcinoma: A multi-center retrospective study

“…Transarterial chemoembolization (TACE) has been confirmed to be efficient in the improvement of prognosis of advanced and inoperable patients [11][12][13], but whether postoperative TACE (p-TACE) could benefit patients following radical resection remains controversial. The clinical value of p-TACE for ICC has been evaluated in previously few studies [14][15][16][17][18][19], but it has yet reached a conclusion.…”