S0007 Palliative Endoscopic Biliary Radiofrequency Ablation and Percutaneous Biliary Radiofrequency Ablation as Therapies for Patients With Unresectable Cholangiocarcinoma: A Meta-Analysis on Overall Survival Outcomes

Abstract

INTRODUCTION: Cholangiocarcinoma (CCA) has an extremely poor prognosis with literature demonstrating 5-year survival rates between 2 and 25% and median survival between 3 and 6 months for unresectable disease. Up to 80% of patients presenting with CCA have unresectable disease and these patients are left with palliative treatment options. Mainstay palliative therapy (apart from systemic chemotherapy) includes percutaneous or endoscopic stenting, however these treatment options have a relatively poor survival benefit. Radiofrequency ablation is a relatively new technology that delivers thermal energy at the tumor site resulting in locoregional coagulative necrosis. This meta-analysis aims to compare survival data for patients who underwent endoscopic radiofrequency ablation (ERFA) or percutaneous radiofrequency ablation (PRFA) as a palliative therapy for unresectable CCA. METHODS: A PubMed search was conducted for manuscripts and abstracts that analyzed survival outcomes in patients undergoing either ERFA or PRFA for the treatment of unresectable CCA. Studies were included in the meta-analysis only if extrapolation of CCA specific survival was made available. Studies analyzing post-surgical disease or recurrent lesions were excluded. A Kaplan Meier curve was generated from pooled survival data and a Forest plot compiled for comparison of mean survival between studies. RESULTS: There were 23 total studies that met our criteria and included in quantitative analysis. 14 studies analyzed ERFA and the survival outcomes of 213 patients. Additionally, 9 studies analyzed 114 patients and their survival outcomes after undergoing PRFA. One study included 30 patients undergoing either PRFA or ERFA. The mean survival of the ERFA group was 12.1 ± 4.4 months and mean survival of the PRFA group was 14.3 ± 7.5 months. The combined mean survival of all 357 patients undergoing palliative ERFA or PRFA was 12.8 ± 5.4 months. The median survival of the ERFA group was 12.0 months and the median survival of the PRFA group was 10.8 months. The overall median survival of all patients undergoing biliary RFA was 10.8 months. CONCLUSION: Biliary radiofrequency ablation seems to be reasonable for palliation in those with previously untreated, unresectable CCA with evidence of increased mean and median survivals relative to published data. However further studies are required to draw meaningful conclusions regarding survival benefit.Figure 1.: Forest Plot of mean survival of patients undergoing biliary RFA (ERFA and PRFA) for treatment of unresectable cholangiocarcinoma.Figure 2.: Kaplan-Meier survival curve of patients undergoing biliary RFA (ERFA and PRFA) for treatment of unresectable cholangiocarcinoma.