4:21 PM Abstract No. 180 Primary technique efficacy, local tumor progression, patient survival, and complications following outpatient percutaneous image-guided thermal ablation of primary intrahepatic cholangiocarcinoma

Abstract

The purpose of this study was to determine primary technique efficacy (TE), time to local tumor progression (TTLP), patient survival and complications following outpatient percutaneous image-guided thermal ablation as the initial treatment for primary intrahepatic cholangiocarcinoma (ICC). Ethics board approved, single arm, retrospective, cohort study of patients with pathologically proven primary ICC treated with percutaneous thermal ablation as the initial therapy at a tertiary referral center from 1999 to 2017. Primary TE, defined as no tumor enhancement on the first post-thermal ablation follow-up imaging, was determined. Local tumor progression was defined as abnormal liver enhancement with nodularity or mass effect adjacent to an ablation zone on a follow-up CT or MRI. Complications were graded as per SIR guidelines. Factors affecting primary TE, TTLP, and complication rates were analyzed. The patient cohort consisted of 6 females and 10 males. Mean patient age was 65 years (range, 47-81). All 16 patients had chronic liver disease (hepatitis B: 6 patients, hepatitis C: 4, alcohol related cirrhosis: 3, NASH: 2, and hemochromatosis: 1). All 16 patients were Child-Pugh class A. Mean tumor diameter was 26 mm (range, 12-44). 12 patients were diagnosed with biopsy performed at the time of ablation, whereas 4 were diagnosed with biopsy prior to consultation for thermal ablation. 13 patients were treated with radiofrequency ablation and 3 patients treated with microwave ablation. Primary TE was 81%. No major complications occurred. Mean follow-up was 32 months (range, 4-135). In patients with primary effectively ablated tumors, 3, 14 and 25-month local tumor progression-free survival were 91.7 ± 8.0% [± SE], 81.5 ± 11.9% and 48.9 ± 19.2%. Overall, cumulative 1, 2 and 3-year patient survival was 73.3% (11/15), 53.8% (7/13) and 41.7% (5/12), there was 1 patient lost to follow-up at 4 months post procedure. Tumor size was associated with both reduced primary TE and shorter TTLP (p<0.05). Thermal ablation is a safe and effective treatment for small primary intrahepatic cholangiocarcinoma.