Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma

Lucas M. Boehm, Thejus T. Jayakrishnan, John T. Miura, Anthony J. Zacharias, Fabian Johnston, Kiran K. Turaga, T. Clark Gamblin

Research output: Contribution to journalReview article

Abstract

Background: Hepatic artery based therapies (HAT) are offered for patients with unresectable intrahepatic cholangiocarcinoma (ICC). We aimed to evaluate the comparative effectiveness of HAT-hepatic arterial infusion (HAI), transcatheter arterial chemoembolization (TACE), drug-eluting bead TACE (DEB-TACE), and Yttrium90 radioembolization (Y-90) for unresectable ICC. Methods: A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013004830) that utilized PubMed (2003-2013). Primary outcome was median overall survival (OS), and secondary outcomes were tumor response to therapy and toxicity. Results: A total of 20 articles (of 793, n = 657 patients) were selected for data extraction. Highest Median OS was observed for HAI (22.8, 95% CI 9.8-35.8) months versus Y90 (13.9, 9.5-18.3) months versus TACE (12.4, 10.9-13.9) months versus DEB-TACE (12.3, 11-13.5) months. Response to therapy (complete and partial) was highest for HAI (56.9%, 95%CI 41.0-72.8) versus Y90 (27.4%, 17.4-37.5) versus TACE (17.3%, 6.8-27.8). The grade III/IV toxicity (Events per patient) was highest for HAI (0.35, 95% CI 0.22-0.48) versus TACE (0.26, 0.21-0.32) versus DEB-TACE (0.32, 0.17-0.48). Conclusion: For patients with unresectable ICC treated with HAT, HAI offered the best outcomes in terms of tumor response and survival but may be limited by toxicity.

Original languageEnglish (US)
Pages (from-to)213-220
Number of pages8
JournalJournal of Surgical Oncology
Volume111
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

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Keywords

  • Chemotherapy
  • Cholangiocarcinoma
  • Hepatectomy
  • Liver blood supply
  • Regional perfusion

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Boehm, L. M., Jayakrishnan, T. T., Miura, J. T., Zacharias, A. J., Johnston, F., Turaga, K. K., & Gamblin, T. C. (2015). Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma. Journal of Surgical Oncology, 111(2), 213-220. https://doi.org/10.1002/jso.23781