Locoregional therapies in patients with intrahepatic cholangiocarcinoma: A systematic review and pooled analysis

Abstract

Background: Locoregional treatments (LRT) including radioembolisation (SIRT), transarterial chemoembolisation (TACE), hepatic arterial infusion (HAI) of chemotherapy, external beam radiotherapy (EBRT) and ablation have been studied for the management of intrahepatic cholangiocarcinoma (iCC). The aim of this systematic review was to provide outcome benchmarks for clinical trial design. Methods: Identification of studies reporting outcomes of patients treated with LRT for iCC was performed using PubMed and Embase. Pooled weighted means were calculated for progression-free survival (PFS) and overall survival (OS); meta-analysis of proportions was used for estimation of pooled response rate. Results: 6325 entries were reviewed; 93 studies were eligible, representing 101 cohorts and 3990 patients: 15 cohorts (645 patients) for ablation, 18 cohorts (541 patients) for EBRT, 27 cohorts (1232 patients) for SIRT, 22 cohorts (1145 patients) for TACE, 16 cohorts (331 patients) for HAI and 3 cohorts (96 patients) not pooled. 74% of the studies were retrospective, 99% non-randomised. The pooled mean weighted OS was 30.2 months (95% confidence interval (CI): 21.8-38.6) for ablation, 18.9 (14.2-23.5) for EBRT, 14.1 (12.1-16.0) for SIRT, 15.9 (12.9-19.0) for for HAI. The pooled complete response rate was 93.9% for ablation. When analysed together, SIRT, TACE and HAI had a pooled mean weighted OS of 15.7 months, and 25.2 months for patients treated in first-line with concomitant systemic chemotherapy. Conclusions: Available literature on LRT for iCC was heterogeneous and of insufficient quality to make strong recommendations. Ablation achieved satisfactory outcomes, and may be recommended when surgery is not feasible.

Liver Transplantation for Intrahepatic Cholangiocarcinoma: Ready for Prime Time?

“…[ 59 ] A recently published systematic review and pooled analysis of LRTs in iCCA found a pooled mean weighted OS of 18.9 months (95% CI, 14.2–23.5) for EBRT, 14.1 months (95% CI, 12.1–16.0) for radioembolization, 15.9 months (95% CI, 12.9–19.0) for TACE, and 21.3 months (95% CI, 15.4–27.1) for hepatic artery infusion. [ 60 ] Another recent systematic review and meta‐analysis by Mosconi et al specifically evaluated intra‐arterial therapies such as TACE and transarterial radioembolization (TARE). [ 61 ] Thirty‐one articles comprising 1695 patients (TACE, n = 906; TARE, n = 789) were identified.…”

Outcome and Safety after 103 Radioembolizations with Yttrium-90 Resin Microspheres in 73 Patients with Unresectable Intrahepatic Cholangiocarcinoma—An Evaluation of Predictors

“…However, not all lesions are eligible for ablation. In tumors that are large or unfavorably located for ablation, trans-arterial therapies seem to play an important role [31].…”

Selective Internal Radiation Combined with Chemotherapy Maintains the Quality of Life in Intrahepatic Cholangiocarcinomas

“…A high proportion of patients were down-staged to surgical intervention and had favorable post-surgical outcomes. The results of other studies confirmed the promising outcomes with the locoregional treatment of ICCs; however, this should be confirmed in randomized studies [ 17 ].…”

“…A multiple single-center series reported the results of SIRT among patients with locally advanced ICCs [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Systematic reviews have suggested the activity of a SIRT treatment as well as other locoregional therapies [ 17 , 30 , 31 ]. The efficacy of SIRT has recently been confirmed with an acceptable safety profile in the prospective MISPHEC trial [ 16 ].…”