Endoscopic radiofrequency ablation plus a novel oral 5-fluorouracil compound versus radiofrequency ablation alone for unresectable extrahepatic cholangiocarcinoma

Abstract

Endoscopic radiofrequency ablation (RFA) is a new ablative treatment for unresectable extrahepatic cholangiocarcinoma (EHCC). A novel 5-fluorouracil compound, S-1 (Taiho Pharmaceutical Co, Ltd, Tokushima Plant. Japan), has been widely used as a key drug with first-line or second-line chemotherapy for the treatment of advanced cholangiocarcinoma. The aim of this study was to evaluate the clinical efficacy and safety of endoscopic RFA combined with S-1 for the treatment of unresectable locally advanced EHCC. Patients with unresectable EHCC were prospectively randomized to 1 of 2 groups: the RFA+ S-1 group and the RFA group. Median overall survival (OS), stent patency time, Karnofsky performance status (KPS) score, and adverse events rate were analyzed. The median OS was longer in the RFA+ S-1 group (n= 37) than that in the RFA group (n= 38) (16.0 months [95% confidence interval, 13.1-19.0] vs 11.0 months [95% confidence interval, 9.7-12.3]; P< .001). Stent patency time was significantly longer in the RFA+ S-1 group than that in the RFA group (6.6 ± 1.5 vs 5.6 ± .1 months, P= .014). KPS scores at postoperative month 9 (51.6 ± 17.0 vs 40.4 ± 16.4, P= .012) and month 12 (35.2 ± 18.3 vs 23.9 ± 11.4, P= .014) were all higher in the RFA+ S-1 group than those in the RFA group (P< .05). The incidence of ERCP-related adverse events was not significantly different between RFA+S-1 and RFA groups (8.1% vs 10.5%, P > .05). For the treatment of locally advanced EHCC, endoscopic RFA combined with S-1 is associated with longer survival and stent patency and improved functional status than RFA alone. (Clinical trial registration number: NCT02592538.).