Chemoembolization with Degradable Starch Microspheres for Treatment of Patients with Primary or Recurrent Unresectable, Locally Advanced Intrahepatic Cholangiocarcinoma: A Pilot Study
Chemoembolization with Degradable Starch Microspheres for Treatment of Patients with Primary or Recurrent Unresectable, Locally Advanced Intrahepatic Cholangiocarcinoma: A Pilot Study
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DOI：
10.1007/s00270-019-02344-0
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发表时间：
2019-12-01
影响因子：
2.9
通讯作者：
Kuhl, Christiane
中科院分区：
文献类型：
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作者：
Goerg, Fabian;Zimmermann, Markus;Kuhl, Christiane
目的评价TACE与可降解淀粉微球（DSM-TACE）在不可切除的肝内胆管癌（ICC）患者的疗效和并发症的发生率，无论有或没有以前的主要肝切除术（MLR）。方法这是一项回顾性单中心研究21例（年龄63 - 15岁），无论是不可切除的ICC进行性全身化疗或不可切除的肝内肿瘤复发后，以前的MLR。患者在2012年8月至2016年7月期间接受多药（顺铂/多柔比星/丝裂霉素C）DSM-TACE治疗，每4周重复3次。使用RECIST 1.1评价影像学缓解。总生存率（OS）和并发症发生率，分层的历史MLR，进行了investigated.ResultsPatients共64 DSM-TACE会议。2例患者（无MLR）在一次顺利的DSM-TACE治疗后失访。1例患者在一次DSM-TACE治疗后接受了活体供肝移植，获得部分缓解。在其余18例患者中，根据RECIST 1.1，影像学缓解为：2/18例（11.1%）完全缓解; 9/18例（50%）PR，7/18例（38.9%）疾病稳定，客观缓解率为61.1%，疾病控制率为100%。客观缓解患者的中位OS（18.0个月）显著长于疾病稳定患者的生存期（4.8个月）（p=0.001）。MLR患者的中位OS（12.5个月）与无MLR患者的中位OS（13.2个月）相似。21例患者中，2（9.5%）开发后介入肝胆管脓肿，这些患者中的一个死亡，由于随后sepsis.ConclusionDSM-TACE是一种有效的治疗不可切除的，否则治疗难治性肝内胆管细胞癌，即使在这些患者肝内疾病复发后，先前MLR.Level of EvidenceLevel II，治疗研究。
PurposeTo evaluate efficacy and complication rates of TACE with degradable starch microspheres (DSM-TACE) in patients with unresectable intrahepatic cholangiocarcinoma (ICC) with or without prior major liver resection (MLR).MethodsThis is a retrospective single-center study on 21 patients (age 6315 years) with either unresectable ICC progressive under systemic chemotherapy or unresectable intrahepatic tumor recurrence after prior MLR. Patients were treated by multi-agent (cisplatin/doxorubicin/mitomycin C) DSM-TACE between August 2012 and July 2016, repeated 3 times at 4-week intervals. Imaging response was evaluated using RECIST 1.1. Overall survival (OS) and complication rates, stratified by history of MLR, were investigated.ResultsPatients underwent a total 64 DSM-TACE sessions. Two patients (without MLR) were lost to follow-up after one uneventful DSM-TACE session. One patient underwent living-donor-liver transplantation after one DSM-TACE-session yielding partial remission. Of the remaining 18 patients, imaging response according to RECIST 1.1 was: complete remission in 2/18 (11.1%); PR in 9/18 (50%), and stable disease in 7/18 (38.9%), yielding an objective response rate of 61.1% and a disease control rate of 100%. Median OS of patients with objective response was significantly longer (18.0 months) than that of survival of patients with stable disease (4.8 months) (p=0.001). Median OS of patients with MLR (12.5 months) was similar to that of patients without MLR (13.2 months). Of 21 patients, 2 (9.5%) developed post-interventional hepatobiliary abscesses, and one of these patients died due to subsequent sepsis.ConclusionDSM-TACE is an effective treatment for unresectable and otherwise therapy-refractory intrahepatic cholangiocarcinoma, even in those patients with intrahepatic disease recurrence after prior MLR.Level of EvidenceLevel II, therapeutic study.