title: Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol: a 2-center study.
abstract: BACKGROUND
  Unresectable intrahepatic cholangiocarcinoma has a poor prognosis, with a median survival of 5 to 8 months without treatment. Response and survival after chemoembolization were evaluated.
  
  
  METHODS
  Lobar or segmental chemoembolization with cisplatinum, doxorubicin, mitomycin-C, ethiodol, and polyvinyl alcohol particles was performed at monthly intervals for 1-4 sessions until the entire intrahepatic tumor burden was treated. Cross-sectional imaging and clinical and laboratory evaluation were performed before treatment, 1 month after treatment, and then every 3 months. A second cycle of treatment was performed for intrahepatic recurrence. Toxicity was assessed using NCI CTC v.3.0. Response was evaluated using RECIST criteria, and survival was estimated with Kaplan-Meier analysis.
  
  
  RESULTS
  Sixty-two patients were treated. Thirty-seven had pathologically proven cholangiocarcinoma, and 25 had poorly differentiated adenocarcinoma of unknown primary, likely cholangiocarcinoma. One hundred and twenty-two total procedures were performed during the initial cycle of treatment (mean, 2.0 per patient). Twenty patients received a second cycle, for a total of 165 procedures. There were 5 major complications. Thirty-day disease-specific mortality was 0%. Forty-five of 62 patients were evaluable for morphologic response after completion of their initial cycle: 11% (n = 5) partial responses, 64% (n = 29) stable, and 24% (n = 11) progressed. Median time to progression from first chemoembolization was 8 months, with 28% free of progression at 12 months. Median survival from time of diagnosis was 20 months, with 1-, 2-, and 3-year survival of 75%, 39%, and 17%, respectively. Median survival from time of first chemoembolization was 15 months, with 1-, 2-, and 3-year survival of 61%, 27%, and 8%, respectively. There was no statistically significant difference in survival between patients with cholangiocarcinoma and those with poorly differentiated adenocarcinoma. Patients who also received systemic chemotherapy had improved overall survival (median 28 vs 16 months, P = .02; HR, 1.94; 95% CI, 1.13-3.33).
  
  
  CONCLUSIONS
  Chemoembolization provided local disease control (PR + SD) of intrahepatic cholangiocarcinoma and adenocarcinoma of unknown primary in 76%. Overall survival after chemoembolization showed the best outcomes for those receiving multidisciplinary integrated liver-directed and systemic therapies.
authors.affiliation: Division of Interventional Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Matthew V
authors.initials: MV
authors.lastname: Kiefer
authors.forename: Marissa
authors.initials: M
authors.lastname: Albert
authors.forename: Madeline
authors.initials: M
authors.lastname: McNally
authors.forename: Mary
authors.initials: M
authors.lastname: Robertson
authors.forename: Weijing
authors.initials: W
authors.lastname: Sun
authors.forename: Douglas
authors.initials: D
authors.lastname: Fraker
authors.forename: Kim
authors.initials: K
authors.lastname: Olthoff
authors.forename: Kathleen
authors.initials: K
authors.lastname: Christians
authors.forename: Sam
authors.initials: S
authors.lastname: Pappas
authors.forename: William
authors.initials: W
authors.lastname: Rilling
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009382:Neoplasms, Unknown Primary / Q000628:therapy*; D011142:Polyvinyl Alcohol / Q000008:administration & dosage
chemical_list: D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; D011142:Polyvinyl Alcohol; D002945:Cisplatin