Armeen Mahvash, MDInterventional RadiologyUT MD Anderson Cancer Center
Locoregional Therapies for Cholangiocarcinoma
Treatment Options
Ablation Radiofrequency Microwave Irreversible Electroporation (abstract)
Transarterial Chemoembolization (TACE) Conventional / Oily TACE Drug Eluting Bead TACE
Selective Internal Radiation Therapy / Yttrium 90 Radioembolization Therasphere / Glass - HCC SIRSpheres / Resin - CRC
Ablative Therapy in ICC
Reference Patients Lesions Type Size/Success Median LPFS Median OS Complication
Kim, 2011 13 17 RFA <5cm/100%
>5cm/0%
32 months 38 months Abscess/ Death
Giorgio, 2011
101 Recurrent9 Primary
12 RFA <3.4cm/100%
>4cm/ 0%
Primary – 83% alive at 5yrs
None
Yu, 2011 15 24 MW <5cm/90%
>5cm/33%
10 months Abscess x 2Seeding
Xu, 2012 1810 Recurrent8 Primary
25 RFA/MW <4.3cm/100%>6.4cm/0%
RFS - months
Recurrent- 6 months Primary –29 months
FeverPartial PVT
Metaanalysis of TACE for ICC
Ray, JVIR, 2013
Conventional TACEReference Patients Chemotherapy Prior Chemo Extrahepatic
DiseaseMedian OS Complications
Herber, 2007 1558 sessions
Mitomycin C 4 None 16 months GI ulcer
Gusani,2008 42199 sessions
Gemcitabine, Cisplatin, OxaliplatinTACI+Embo
NA 45% 9months AMIAbscessBilirubin x 2Platelets x 2
Park, 2011 72 TACE2.5 session/pt83 BSC
Cisplatin NA 72% TACE – 12 mBSC – 3 m
Grade 3 – 24%
Keifer, 2011 62165 session
Cisplatin, Doxorubicin, Mitomycin
29% 31% 15 months Grade 3 – 5 pts
Vogl,2011 115819 session
Various NA None 13 months None
Scheuermann, 2013
32131 session
Mitomycin -29DEB - 3
NA NR 11 months Sepsis x 3
Hyder, 2013 1982 sessions/pt
TACE – 65%DEB – 6%TAE- 6%Y90 – 23%
28% TACE – 13 mDEB – 10 mTAE – 14 mY90 – 11 m
Grade 3 - 8%
Drug Eluting Bead(DEB) TACEReference Patients Chemotherap
yPrior Chemo
Extrahepatic Disease
Median OS Complications
Aliberti, 2008 1129 sessions
Doxorubicin75mg/150mg
No No 13 months Abscess
Poggi, 2009 930 sessions37 cycles
Oxaliplatin 50mg + Oxaliplatin/Gemcitabine Systemic Chemo
No No 30 months Grade 3 – 11%
Kuhlmann, 2012
2641 sessions
Irinotecan 200mg
19% 51% 11.7 months Grade 3 – 9/26Grade 5 - 1
Yttrium 90 Radioembolization
Reference Patients Device Prior Chemo Extrahepatic Mets
Median OS Complications
Saxena, 2010 2525 sessions
SS/resin 72% 48% 9 months Grade 3 – 12%Death x 2
Hoffman, 2012
3334 sessions
SS/resin 79% 24% 22 months Grade 3 - 0%
Mouli, 2013 4692 sessions
TS/glass 35% 35% Peripheral – 15 monthsInfiltrative – 6 months
Grade 3 – 18%
Rafi, 2013 1924 sessions
SS/resin 100% 58% 345 days Grade 3 – 11%
Future Direction
Prospective Trials Needed Combination Therapy
Locoregional + Systemic
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