title: Treatment of unresectable cholangiocarcinoma with gemcitabine-based transcatheter arterial chemoembolization (TACE): a single-institution experience.
abstract: BACKGROUND
  Survival for patients with unresectable cholangiocarcinoma is reported to range from only 5-8 months without treatment. Systemic chemotherapy has not been shown to significantly improve survival, but newer regimens involving gemcitabine have shown increased response rates. Transcatheter arterial chemoembolization (TACE) has been shown to prolong survival in hepatocellular carcinoma patients, but experience using TACE in the treatment of cholangiocarcinoma is limited. We report our experience treating cholangiocarcinoma with TACE using chemotherapeutic regimens based on the well-tolerated drug gemcitabine.
  
  
  METHODS
  Forty-two patients with unresectable cholangiocarcinoma were treated with one or more cycles of gemcitabine-based TACE at our institution. Chemotherapy regimens used for TACE included: gemcitabine only (n=18), gemcitabine followed by cisplatin (n=2), gemcitabine followed by oxaliplatin (n=4), gemcitabine and cisplatin in combination (n=14), and gemcitabine and cisplatin followed by oxaliplatin (n=4).
  
  
  RESULTS
  Patients were 59 years of age (range 36-86) and received a median of 3.5 TACE treatments (range 1-16). Thirty-seven patients (88%) had central cholangiocarcinoma, and five (12%) had peripheral tumors. Nineteen patients (45%) had extrahepatic disease. Grade 3 adverse events (AEs) after TACE treatments were seen in five patients, whereas grade 4 AEs occurred in two patients. No patients died within 30 days of TACE. Median survival from time of first treatment was 9.1 months overall. Results did not vary by patient age, sex, size of largest initial tumor, or by the presence of extra-hepatic disease. Treatment with gemcitabine-cisplatin combination TACE resulted in significantly longer survival (13.8 months) compared to TACE with gemcitabine alone (6.3 months).
  
  
  CONCLUSIONS
  Our report represents the largest series to date regarding hepatic-artery-directed therapy for unresectable cholangiocarcinoma and provides evidence in favor of TACE as a promising treatment modality in unresectable cholangiocarcinoma. Our results suggest that gemcitabine-based TACE is well tolerated and confers better survival when given in combination therapy (with cisplatin or oxaliplatin) for patients with unresectable cholangiocarcinoma.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.forename: Fady K
authors.initials: FK
authors.lastname: Balaa
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Albert B
authors.initials: AB
authors.lastname: Zajko
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D001706:Biopsy; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002945:Cisplatin / Q000008:administration & dosage; D000075202:Contraindications; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012189:Retrospective Studies; D012264:Ribonucleotide Reductases / Q000037:antagonists & inhibitors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D012264:Ribonucleotide Reductases; D002945:Cisplatin; D000093542:Gemcitabine