Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC)

Vogl, Thomas J.; Zangos, Stephan; Eichler, Katrin; Gruber‐Rouh, Tatjana; Hammerstingl, Renate; Weisser, Philipp

doi:10.1055/s-0032-1312842

Cited by 7 publications

(3 citation statements)

References 37 publications

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“…Obstructive jaundice, whether of a malignant or benign nature, has an interdisciplinary therapeutic approach with the participating departments of surgery, gastroenterology, and radiology. The mostly used standard of diagnosis and therapy, even in palliative cases, but also in further assessment, is endoscopic intervention [1] (endoscopic retrograde choledochopancreatography, ERCP).…”

Section: Introductionmentioning

confidence: 99%

Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

et al. 2019

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Purpose The goal of this study was to evaluate the experience of 11 years of wire-guided forceps biopsy via PTCD in patients with obstructive jaundice. Materials and methods In a retrospective approach, 56 biopsies in 51 patients were analyzed (22 female, 29 male). Data was collected from 2006 to 2016. Mean age was 71 years (range: 34 – 86 years). Data was extracted from dig. Patients’ records (KIS, PACS, RIS) to be analyzed in Microsoft Excel. Results All 56 procedures were technically successful. Stenosis in anastomoses were benign due to scarring in 7 patients and in 9 due to papillitis or others. In 4 patients, results in anastomosis were malignant. In 19 patients without anastomosis, CCC was the diagnosis, thereof 10 klatskin, 9 stenosis in other locations, followed by gastric, pancreatic, and colon carcinoma in 5, 3, and 2 patients. Three patients had a CUP (multimetering in case of more than 1 related category). Overall results were 35 mal. and 16 benign, 76.8 % of all proc. had a correct histopathologic result, and 23.2 % were false negative. Sensitivity was 65.8 %, which results in negative predictive value of 58.1 %. There was no false positive and so specificity was 100 %, as was the positive predictive value. False negative results (no malignancy but clinically and imaging suspect) were corrected by rerunning the procedure, by CT-guided biopsy or by 1 PET-CT. In 1 case the surg. sample brought the result. Minor complications occurred in 8 patients: shivering in 1 case, distinct but hemodynamically not relevant hemobilia in 5 cases, 2 portovenal bleedings. All bleedings were short-term and self-limiting. Conclusion Despite good feasibility, low peri- and post-interv. risk and high validity the forceps biopsy via PTCD is not widely used. For experienced interventionalists, it is an effective method for obtaining histology.

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Section: Introductionmentioning

confidence: 99%

Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

et al. 2019

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“…TACE was performed every 6 weeks. After three sessions tumor response was assessed by CT and/or MRI and, depending on outcome, TACE was either continued or interrupted [ 19 , 24 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

Extensive Use of Interventional Therapies Improves Survival in Unresectable or Recurrent Intrahepatic Cholangiocarcinoma

Seidensticker

Doegen

et al. 2016

Gastroenterology Research and Practice

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Aim. To assess the outcomes of patients with unresectable intrahepatic cholangiocellular carcinoma (ICC) treated by a tailored therapeutic approach, combining systemic with advanced image-guided local or locoregional therapies. Materials and Methods. Treatment followed an algorithm established by a multidisciplinary GI-tumor team. Treatment options comprised ablation (RFA, CT-guided brachytherapy) or locoregional techniques (TACE, radioembolization, i.a. chemotherapy). Results. Median survival was 33.1 months from time of diagnosis and 16.0 months from first therapy. UICC stage analysis showed a median survival of 15.9 months for stage I, 9 months for IIIa, 18.4 months for IIIc, and 13 months for IV. Only the number of lesions, baseline serum CEA and serum CA19-9, and objective response (RECIST) were independently associated with survival. Extrahepatic metastases had no influence. Conclusion. Patients with unresectable ICC may benefit from hepatic tumor control provided by local or locoregional therapies. Future prospective study formats should focus on supplementing systemic therapy by classes of interventions (“toolbox”) rather than specific techniques, that is, local ablation leading to complete tumor destruction (such as RFA) or locoregional treatment leading to partial remission (such as radioembolization). This trial is registered with German Clinical Trials Registry (Deutsche Register Klinischer Studien), DRKS-ID: DRKS00006237.

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“…Additional publications were identified after crosschecking of the reference lists of the articles extracted by means of primary selection. A description of the different modalities and techniques available for locoregional therapy is not outlined in this overview; however, it can easily be obtained from other publications [1,2,3,4,5,6,7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Locoregional Therapies of Cholangiocarcinoma

2016

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Background: Cholangiocarcinoma (CC) is the second most primary liver malignancy with increasing incidence in Western countries. Currently, surgical R0 resection is regarded as the only potentially curative treatment. The results of systemic chemotherapy and best supportive care (BSC) in patients with metastatic disease are often disappointing in regard to toxicity, oncologic efficacy, and overall survival. In current practice, the use of different locoregional therapies is increasingly more accepted. Methods: A review of the literature on locoregional therapies for intrahepatic cholangiocarcinoma (ICC) was undertaken. Results: There are no prospective randomized controlled trials. For localized ICC, either primary or recurrent, radiofrequency ablation (RFA) is by far the most commonly used thermal ablation modality. Thereby, a systematic review and meta-analysis reports major complication in 3.8% as well as 1-, 3-, and 5-year overall survival rates of 82, 47, and 24%, respectively. In selected patients (e.g. with a tumor diameter of ≤3 cm), oncologic efficacy and survival after RFA are comparable with surgical resection. For diffuse ICC, different transarterial therapies, either chemotherapy-based (hepatic artery infusion (HAI), transarterial chemoembolization (TACE)) or radiotherapy-based (transarterial radioembolization (TARE)), show extremely promising results. With regard to controlled trials (transarterial therapy versus systemic chemotherapy, BSC or no treatment), tumor control is virtually always better for transarterial therapies and very often accompanied by a dramatic survival benefit and improvement of quality of life. Of note, the latter is the case not only for patients without extrahepatic metastatic disease but also for those with liver-dominant extrahepatic metastatic disease. There are other locoregional therapies such as microwave ablation, irreversible electroporation, and chemosaturation; however, the current data support their use only in controlled trials or as last-line therapy. Conclusion: Dedicated locoregional therapies are commonly used for primary and recurrent ICC as well as liver-only and liver-dominant extrahepatic metastatic disease. Currently, the best evidence and most promising results are available for RFA, HAI, TACE, and TARE. In cohort studies, the overall survival rates are similar to those obtained with surgery or systemic therapies. Prospective randomized controlled trials are warranted to compare safety and efficacy between different surgical, interventional, and systemic therapies, as well as their combinations.

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Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC)

Cited by 7 publications

References 37 publications

Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

Extensive Use of Interventional Therapies Improves Survival in Unresectable or Recurrent Intrahepatic Cholangiocarcinoma

Locoregional Therapies of Cholangiocarcinoma

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