Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma

• Published in: Journal of surgical oncology Vol. 111; no. 2; pp. 213 - 220
• Main Authors: Boehm, Lucas M., Jayakrishnan, Thejus T., Miura, John T., Zacharias, Anthony J., Johnston, Fabian M., Turaga, Kiran K., Gamblin, T. Clark
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.02.2015; Wiley Subscription Services, Inc
• Subjects: Antineoplastic Agents - administration & dosage; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - therapy; Bile Ducts, Intrahepatic; Chemoembolization, Therapeutic; chemotherapy; cholangiocarcinoma; Cholangiocarcinoma - mortality; Cholangiocarcinoma - therapy; Drug Carriers; Embolization, Therapeutic - methods; hepatectomy; Hepatic Artery; Humans; Infusions, Intra-Arterial; liver blood supply; Radiopharmaceuticals - therapeutic use; regional perfusion; Yttrium Radioisotopes - therapeutic use; hepatectomy; chemotherapy; cholangiocarcinoma; regional perfusion; liver blood supply
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.23781

Background Hepatic artery based therapies (HAT) are offered for patients with unresectable intrahepatic cholangiocarcinoma (ICC). We aimed to evaluate the comparative effectiveness of HAT –hepatic arterial infusion (HAI), transcatheter arterial chemoembolization (TACE), drug‐eluting bead TACE (DEB‐TACE), and Yttrium90 radioembolization (Y‐90) for unresectable ICC. Methods A meta‐analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013004830) that utilized PubMed (2003–2013). Primary outcome was median overall survival (OS), and secondary outcomes were tumor response to therapy and toxicity. Results A total of 20 articles (of 793, n = 657 patients) were selected for data extraction. Highest Median OS was observed for HAI (22.8, 95% CI 9.8–35.8) months versus Y90 (13.9, 9.5–18.3) months versus TACE (12.4, 10.9–13.9) months versus DEB‐TACE (12.3, 11–13.5) months. Response to therapy (complete and partial) was highest for HAI (56.9%, 95%CI 41.0–72.8) versus Y90 (27.4%, 17.4–37.5) versus TACE (17.3%, 6.8–27.8). The grade III/IV toxicity (Events per patient) was highest for HAI (0.35, 95% CI 0.22–0.48) versus TACE (0.26, 0.21–0.32) versus DEB‐TACE (0.32, 0.17–0.48). Conclusion For patients with unresectable ICC treated with HAT, HAI offered the best outcomes in terms of tumor response and survival but may be limited by toxicity. J. Surg. Oncol. 2015 111:213–220. © 2014 Wiley Periodicals, Inc.