Clinical study
Radiofrequency Ablation in the Management of Unresectable Intrahepatic Cholangiocarcinoma

https://doi.org/10.1016/j.jvir.2012.01.081Get rights and content

Abstract

Purpose

To evaluate the efficacy of radiofrequency (RF) ablation for treatment of unresectable intrahepatic cholangiocarcinoma (ICC) and to explore the impact of prognostic variables on outcomes.

Materials and Methods

From 2000–2010, 17 patients with 26 ICCs underwent RF ablation at a single institution. None of the patients were surgery candidates. Seven patients had 15 primary ICCs, and 10 patients had 11 recurrent ICCs. The median largest diameter was 4.4 cm (range 2.1–6.8 cm). A percutaneous approach was used in 15 patients, and an open approach was used in 2 patients. Early tumor necrosis, recurrence-free survival, and overall survival were analyzed. Univariate analysis was performed to evaluate 12 clinicopathologic and treatment-related variables associated with recurrence-free survival and overall survival.

Results

Early tumor necrosis was 96.2% (25 of 26 tumors). The median follow-up period after RF ablation was 29 months. The median recurrence-free survival and overall survival were 17 months and 33 months. The 1-year, 3-year, and 5-year survival rates were 84.6%, 43.3%, and 28.9%, with an overall complication rate of 3.6% (1 of 28 sessions). Three variables were found to be closely associated with recurrence-free survival: lymph node metastases (P = .023), tumor differentiation (P = .034), and tumor number (P = .035). The only variable significantly associated with overall survival was tumor differentiation (P = .033).

Conclusions

Preliminary results showed that RF ablation may be an effective treatment for ICC because it achieved an acceptable survival rate in a small population. Prognostic factors might allow better patient selection and outcomes.

Section snippets

Subjects

After institutional review board approval, a retrospective review of medical and imaging records of consecutive patients treated for ICC with RF ablation was performed. There were 30 patients with ICC who presented to our center for RF ablation treatment; 17 of these patients met our criteria. These 17 patients received RF ablation between January 2000 and July 2010. The remaining 13 patients were excluded for nodular ICCs > 7 cm in maximum diameter (6 patients), multifocal lesions (greater

Local Tumor Control

The early ablation success rate after the first RF ablation based on the CT findings at 1 month was 96.2% (25 of 26 tumors, 17 sessions). One patient with recurrent ICC who had residual tumor after initial RF ablation received a second RF ablation, and the tumor was ablated successfully by repeated treatment.

Recurrence Data

After a median follow-up period of 29 months, local recurrence after RF ablation developed in three patients (one patient with primary tumor, two patients with recurrent tumors). All three

Discussion

In recent years, RF ablation has been shown to be effective for treatment of ICC in selected patients (21, 22, 23, 24, 28, 29, 30, 31). For primary ICC, Carrafiello et al (30) reported the results for six patients who underwent percutaneous ultrasound-guided RF ablation. CT scan performed after treatment showed total necrosis in four of six (66%) tumors. However, in this study, no long-term survival data were available owing to a short follow-up period. Kim et al. (28, 31) reported the largest

References (39)

  • I. Endo et al.

    Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection

    Ann Surg

    (2008)
  • T. Nakagawa et al.

    Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma

    World J Surg

    (2005)
  • K.Y. Paik et al.

    What prognostic factors are important for resected intrahepatic cholangiocarcinoma?

    J Gastroenterol Hepatol

    (2008)
  • F.F. Chou et al.

    Surgical treatment of cholangiocarcinoma

    Hepatogastroenterology

    (1997)
  • J. Park et al.

    Natural history and prognostic factors of advanced cholangiocarcinoma without surgery, chemotherapy, or radiotherapy: a large-scale observational study

    Gut Liver

    (2009)
  • T.J. Vogl et al.

    Hepatic intraarterial chemotherapy with gemcitabine in patients with unresectable cholangiocarcinomas and liver metastases of pancreatic cancer: a clinical study on maximum tolerable dose and treatment efficacy

    J Cancer Res Clin Oncol

    (2006)
  • M.V. Kiefer et al.

    Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol: a 2-center study

    Cancer

    (2011)
  • J. Valle et al.

    Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer

    N Engl J Med

    (2010)
  • Z.C. Zeng et al.

    Consideration of the role of radiotherapy for unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 75 patients

    Cancer J

    (2006)
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      In the early stage, radical tumor resection or liver transplantation is the only treatment, but most advanced ICC patients still have recurrence after operation (Hoffmann et al., 2012; Sia et al., 2013). Complete resection, which was feasible for 18%–70% ICC patients, resulted in about 30% of 5-year survival rate, and nearly 2–3 years of median overall survival (Fu et al., 2012). Because ICC usually has no obvious clinical symptoms in the early stage, the surgery is no longer feasible for most advanced patients possibly due to size, location or proliferation of the tumors (Hoffmann et al., 2012).

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    Funding provided by The National Science Foundation for Young Scholars of China (No. 81101745) and incubation fund of public health plan of BSTC (Beijing Science Technology Commission, Z111107067311026).

    None of the authors have identified a conflict of interest.

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