Image-Guided Ablation of Recurrent or Unresectable Intrahepatic Cholangiocarcinoma

Abstract

PurposeTo assess the safety and effectiveness of image-guided ablation of recurrent or unresectable intrahepatic cholangiocarcinoma (ICC). Materials and MethodsIn this retrospective study, 25 patients (14 women; age, 36–84 years) underwent 37 image-guided liver tumor ablation procedures to treat 47 ICCs (May 2004 to January 2022). At initial diagnosis, 20 patients had Stage 1 or 2 disease and 5 had Stage 3 or 4 disease. Before ablation, 19 (76.0%) of the 25 patients had progressed through prior treatments, including resection (n = 11), chemotherapy (n = 11), transarterial embolization (n = 3), or radiotherapy (n = 1); 6 (24.0%) of the 25 patients were treatment naïve. Ablation modality selection was based on patient and tumor characteristics and operator preference. Primary outcomes included local progression–free survival (LPFS) and overall survival (OS) after ablation. Statistical analysis included Kaplan-Meier (KM) survival analyses and Cox proportional hazards models. ResultsThe mean ablated tumor size was 2.0 cm ± 1.2 (range, 0.5–5.0 cm). The 1-, 2-, and 5-year LPFS rates were 84.0% (95% CI, 72.9–96.8), 73.0% (95% CI, 59.0–90.4), and 59.5% (95% CI, 41.6–85.1), respectively. The 1-, 2-, and 5-year secondary LPFS rates were 89.5% (95% CI, 80.2–99.9), 81.9% (95% CI, 69.4–96.6), and 75.6% (95% CI, 60.2–94.9). The 1-, 2-, and 5-year LPFS rates for tumors ≤2 cm in size were all 95.8% (95% CI, 88.2–100.0). The 1-, 2-, and 5-year OS rates were 78.5% (95% CI, 63.5–97.2), 68.4% (95% CI, 51.3–91.1), and 43.5% (95% CI, 23.5–80.5). Larger tumor size was associated with decreased time to local progression (hazard ratio, 1.93; P = .012). ConclusionsPercutaneous ablation provided favorable intermediate to long-term disease control for patients with recurrent or inoperable cholangiocarcinoma.