Park SY, Kim JH, Yoon HJ, Lee IS, Yoon HK, Kim KP (2011) Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma. Clin Radiol, 66(4):322-328
Abstract: The Kaplan-Meier survival analysis showed that the survival period was significantly longer in the TACE group (median 12.2 months) than in the symptomatic treatment (median 3.3 months) group (p <0.001).
Introduction
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy after hepatocellular carcinoma (10 versus 90%, respectively), and has an increasing global incidence and mortality.1-4 Due to a late diagnosis, untreated ICC results in rapid death.7
Most patients with ICC qualify for palliative therapy, including systemic chemotherapy and radiation therapy. However, such options have been regarded as affording little or no improvement in patient survival over supportive therapy alone, as ICC respond poorly to such existing therapies.8-10
there was also the need for further study to compare the clinical outcome and survival benefit of TACE and supportive therapy alone in the palliative treatment of unresectable ICC.
Materials and methods
Patient Population: The exclusion criteria included histologically proven extrahepatic cholangiocarcinoma or Klatskin tumour, patientswho had undergone other local treatment, such as radiofrequency ablation, and patients who had received radiation therapy or systemic chemotherapy.
Tumour staging was classified as follows: stage I disease is a solitary tumour without vascular involvement; stage II disease is a solitary tumour with vascular invasion; stage IIIA disease is multiple tumourswith or without vascular invasion; stage IIIB disease is any tumour with regional lymph node metastasis; and stage IV disease is any tumour with distant metastasis.14,15 Table 1
Evaluation of data: The overall survival period was measured in months fromthe date of diagnosis.
Results
The median number of treatment sessions was 2.5 perpatient (range 1-17 sessions). Patient Survival: At the time of analysis (November 2009), in the TACE group, 67 patients (93%, 67/72) had died and five patients (7%,5/72) remained alive.
Discussion
Cholangiocarcinomas are neoplasms with biliary epithelial cell differentiation; ICC arise within the liver and extrahepatic cholangiocarcinomas originate in the bile duct along the hepatoduodenal ligament.11,24 ICC usually presents as advanced disease at the time of diagnosis, because of the lack of symptoms until late in disease progression, and the overall prognosis is far worse than that of extrahepatic cholangiocarcinoma. 8,11,25
The median survival time of patients with untreated, unresectable ICC has been reported to be 3 months.25 The tumour response rates of palliative systemic chemotherapy for unresectable ICC have been poor and there has been no proven survival benefit over the use of supportive treatment only.9,26 Furthermore, side effects are common with systemic chemotherapy and frequently limit patients’ tolerance of the therapy as well as their quality of life.
The patient survival rates after TACE have been also variable in previous studies due to the small number of study patients in most of these studies, different baseline patients and tumour characteristics, different measurement (median or mean) or time (from the time of diagnosis or from the time of initial treatment) of the survival period, and different chemotherapeutic regimens.7-9,11 Furthermore, all patients were followed until the end of the study (with a high rate of the event; 96%, 149/155), thus making the present data more reliable.
The principal limitation of the present study is its nonrandomized and retrospective design, both of which may have decreased the statistical strength. Nonetheless, the present results support the benefits of future prospective and randomized investigations.
Abstract: The Kaplan-Meier survival analysis showed that the survival period was significantly longer in the TACE group (median 12.2 months) than in the symptomatic treatment (median 3.3 months) group (p <0.001).
Introduction
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy after hepatocellular carcinoma (10 versus 90%, respectively), and has an increasing global incidence and mortality.1-4 Due to a late diagnosis, untreated ICC results in rapid death.7
Most patients with ICC qualify for palliative therapy, including systemic chemotherapy and radiation therapy. However, such options have been regarded as affording little or no improvement in patient survival over supportive therapy alone, as ICC respond poorly to such existing therapies.8-10
there was also the need for further study to compare the clinical outcome and survival benefit of TACE and supportive therapy alone in the palliative treatment of unresectable ICC.
Materials and methods
Patient Population: The exclusion criteria included histologically proven extrahepatic cholangiocarcinoma or Klatskin tumour, patientswho had undergone other local treatment, such as radiofrequency ablation, and patients who had received radiation therapy or systemic chemotherapy.
Tumour staging was classified as follows: stage I disease is a solitary tumour without vascular involvement; stage II disease is a solitary tumour with vascular invasion; stage IIIA disease is multiple tumourswith or without vascular invasion; stage IIIB disease is any tumour with regional lymph node metastasis; and stage IV disease is any tumour with distant metastasis.14,15 Table 1
Evaluation of data: The overall survival period was measured in months fromthe date of diagnosis.
Results
The median number of treatment sessions was 2.5 perpatient (range 1-17 sessions). Patient Survival: At the time of analysis (November 2009), in the TACE group, 67 patients (93%, 67/72) had died and five patients (7%,5/72) remained alive.
Discussion
Cholangiocarcinomas are neoplasms with biliary epithelial cell differentiation; ICC arise within the liver and extrahepatic cholangiocarcinomas originate in the bile duct along the hepatoduodenal ligament.11,24 ICC usually presents as advanced disease at the time of diagnosis, because of the lack of symptoms until late in disease progression, and the overall prognosis is far worse than that of extrahepatic cholangiocarcinoma. 8,11,25
The median survival time of patients with untreated, unresectable ICC has been reported to be 3 months.25 The tumour response rates of palliative systemic chemotherapy for unresectable ICC have been poor and there has been no proven survival benefit over the use of supportive treatment only.9,26 Furthermore, side effects are common with systemic chemotherapy and frequently limit patients’ tolerance of the therapy as well as their quality of life.
The patient survival rates after TACE have been also variable in previous studies due to the small number of study patients in most of these studies, different baseline patients and tumour characteristics, different measurement (median or mean) or time (from the time of diagnosis or from the time of initial treatment) of the survival period, and different chemotherapeutic regimens.7-9,11 Furthermore, all patients were followed until the end of the study (with a high rate of the event; 96%, 149/155), thus making the present data more reliable.
The principal limitation of the present study is its nonrandomized and retrospective design, both of which may have decreased the statistical strength. Nonetheless, the present results support the benefits of future prospective and randomized investigations.
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