Abstract No. 352 - Preliminary experience of drug-eluting bead transcatheter arterial chemoembolization for unresectable cholangiocarcinoma

Abstract

Purpose The diagnosis of intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis. The majority of patients are unresectable at presentation and survival without treatment ranges from 5 to 8 months. The purpose of this study was to evaluate the effectiveness of transcatheter arterial chemoembolization (TACE) using drug-eluting beads (DEB) in patients with ICC. Materials and Methods Retrospective review of 8 patients who underwent DEB TACE for ICC between April 2009 and February 2012 was performed. Demographic, procedural and follow-up data were collected for evaluation of safety, response and survival. Cross-sectional imaging was obtained prior to treatment and at 1, 3, 6 and 12 months follow-up. Patients with adequate performance who demonstrated recurrent disease on follow-up were retreated with DEB TACE. The majority of the patients also received systemic chemotherapy. Therapeutic response was evaluated using RECIST criteria and survival was estimated by Kaplan-Meier analysis. Results All 8 patients (mean age 66.1 years) had biopsy-proven ICC. The mean number of TACE procedures performed was 1.4. All TACE procedures were performed using 300-500 micron LC beads loaded with 75 or 100 mg of Doxorubicin. Mean follow-up was 8.9 months. There was one 30-day mortality from causes unrelated to the procedure. One patient was lost to follow-up. Of the remaining patients, two demonstrated partial response, three demonstrated stable disease (42.9%), and two demonstrated progression of disease by RECIST criteria. Mean survival was 9.6 months, with 3, 6 and 12-month survival of 86%, 73% and 44%, respectively, by Kaplan Meier analysis. One patient developed a biloma that was drained percutaneously. Otherwise, no major complications were reported. Conclusion Based on this small sample, DEB TACE can be performed safely in patients with ICC with the majority of patients demonstrating partial response or stable disease. DEB TACE appears to be an appropriate palliative treatment option in patients with ICC and may offer a survival benefit when compared with historical controls.