Developments of treatment of advanced intrahepatic cholangiocarcinoma: An analysis of systemic and local therapy modes in 57 patients.

Abstract

346 Background: Treatment of advanced CCC remains difficult. Sophisticated therapy of individual locations is essential due to differing biological characteristics. Apart from recent systemic therapeutic approaches, combined treatments using, among others, locally ablative procedures offer chances of extended life expectancy. Methods: This analysis is based on a phase II study on treatment of advanced BTC (biliary tract cancer) with gemcitabine/docetaxel(G/D) in 79 patients (pts).Observing purely intrahepatic CCC, omitting Klatskin tumors, modes of therapy were advanced further. In addition to local ablation by TACE (TA) systemic therapy was modified using Gemcitabine/Oxaliplatin(G/O). TACE could only be employed initially in purely intrahepatic inoperable findings. Treatment was later adjusted using local brachytherapy followed by intraarterial chemotherapy with 5-FU (AL + i.a.). A retrospect data analysis of 57 pts diagnosed with advanced intrahepatic CCC was deployed after collecting cases prospectively. A matched pair analysis in relation to data from systemic treatment was performed. Ultimately, 5 groups were formed: 1- 12 pts being treated with TACE only (TA); 2- 15 pts receiving TACE initially followed by systemic therapy of progressive disease (TA+G/D); 3- 11 pts receiving G/D; 4- 14 pts receiving G/O; 5- 5 pts receiving AL+i.a. Treatment continued until either disease progressed or inacceptable side effects occurred. Results: Median time of survival in the TA group was 4.2 months, TA+G/D 20.1 months, G/D 8.5 months and G/O 15.0 months. Currently no conclusive data has been obtained in the AL+i.a. group, yet. Median time to tumour progress was 2.1 months in TA, 5.1 months in TA+G/D, 3.5 months in G/D and 7.7 months in G/O. In the G/O group a case of secondary respectability occurred. Results were achieved with an acceptable toxicity profile and satisfactory quality of life. Conclusions: When the advanced intrahepatic CCC, voiding Klatskin tumours, are limited to the liver and do not offer the possibility of surgical intervention, a combination of treatments should be commenced. Improved systemic protocols can additionally achieve extended time of survival.