Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population‐based analysis

Abstract

Background Little data regarding the selection of nonsurgical therapies for localized intrahepatic cholangiocarcinoma (ICC) are available. Methods A cohort of nonsurgically managed patients with American Joint Commission on Cancer clinical stage I/II ICC in the United States from 2004 to 2013 were identified in the National Cancer Database. Overall survival (OS) was compared according to treatment options (radiofrequency ablation [RFA] vs chemoradiotherapy) using propensity‐score matching. Results Among 505 patients, 86 patients were treated with RFA and 419 patients were treated with chemoradiotherapy. After propensity matching (n = 84, each group), 5‐year OS was 17.6% among patients who underwent RFA vs 3.8% among patients receiving chemoradiotherapy (P < .001). On bivariate analysis, RFA was related to an OS benefit (hazard ratio, 0.46; 95% confidence interval, 0.33‐0.66; P < .001). Specifially, a stage‐specific subgroup analysis revealed a survival benefit in favor of RFA among stage I patients (5‐year OS; RFA: 20.1% vs chemoradiotherapy: 3.7%, P < .001), whereas no difference in OS was noted among patients with stage II disease. Conclusion Among ICC patients with small (≤5 cm), solitary ICC without vascular invasion, RFA was associated with better survival compared with chemoradiotherapy.

Conventional, functional and radiomics assessment for intrahepatic cholangiocarcinoma

“…Several researches have shown that these treatments, alone or in combination with chemotherapy, improve Overall Survival (OS) [ 24 ]. In a cohort of non surgical treated small (≤ 5 cm) iCCA, staged as AJCC I/II, RFA-treated patients showed better survival respect to chemoradiotherapy [ 23 ], results reported by a recent meta-analysis, too [ 24 ]. Consequently, RFA is the treatment of choice in small ICCs.…”

Italian Clinical Practice Guidelines on Cholangiocarcinoma – Part II: Treatment

“…Among the different locoregional treatments, RFA as compared with palliative treatment has been widely suggested to carry a survival benefit in small, solitary iCCA or in patients with local recurrence or residual tumor after surgery with curative intent. For example, in a cohort of nonsurgically-managed patients with small ( ≤ 5 cm) solitary iCCA without vascular invasion who were staged as AJCC I/II in the National Cancer Database, RFA-treated patients showed better survival compared with chemoradiotherapy [152] , a finding that has been supported by a recent meta-analysis [153] . Therefore, in the subset of unresectable patients with small iCCA, RFA is emerging as a treatment of choice similar to small, early hepatocellular carcinoma, although this needs to be supported by adequate trials.…”

Radiofrequency Ablation vs. Surgical Resection for Small Early-Stage Primary Intrahepatic Cholangiocarcinoma

“…While the median survival rate of resection ICC patients was 27.6 months, it was only 12.9 months for the non-surgical candidates with varied palliative treatment in a study by Dhanasekaran et al ( 21 ). Recently, Wu et al ( 22 ) found that for patients with unresectable ICC, RFA was associated with significantly better survival rates compared with chemoradiotherapy. RFA was recommended as one of the standard treatments for ICC in the European Association for the Study of the Liver (EASL) guidelines, although the evidence level was only C2 ( 6 ).…”