title: Metaanalysis of survival, complications, and imaging response following chemotherapy-based transarterial therapy in patients with unresectable intrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  Unresectable intrahepatic cholangiocarcinoma represents a devastating illness with poor outcomes when treated with standard systemic therapies. Several smaller nonrandomized outcomes studies have been reported for such patients undergoing transarterial therapies. A metaanalysis was performed to assess primary clinical and imaging outcomes, as well as complication rates, following transarterial interventions in this patient population.
  
  
  METHODS
  By using standard search techniques and metaanalysis methodology, published reports (published in 2012 and before) evaluating survival, complications, and imaging response following transarterial treatments for patients with unresectable intrahepatic cholangiocarcinoma were identified and evaluated.
  
  
  RESULTS
  A total of 16 articles (N = 542 subjects) met the inclusion criteria and are included. Overall survival times were 15.7 months ± 5.8 and 13.4 months ± 6.7 from the time of diagnosis and time of first treatment, respectively. The overall weighted 1-year survival rate was 58.0% ± 14.5. More than three fourths of all subjects (76.8%) exhibited a response or stable disease on postprocedure imaging; 18.9% of all subjects experienced severe toxicities (National Cancer Institute/World Health Organization grade ≥ 3), and most experienced some form of postembolization syndrome. Overall 30-day mortality rate was 0.7%.
  
  
  CONCLUSIONS
  As demonstrated by this metaanalysis, transarterial chemotherapy-based treatments for cholangiocarcinoma appears to confer a survival benefit of 2-7 months compared with systemic therapies, demonstrate a favorable response by imaging criteria, and have an acceptable postprocedural complication profile. Such therapies should be strongly considered in the treatment of patients with this devastating illness.
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA. charles.ray@ucdenver.edu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ray
authors.forename: Anthony
authors.initials: A
authors.lastname: Edwards
authors.forename: Mitchell T
authors.initials: MT
authors.lastname: Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Leong
authors.forename: Kimi
authors.initials: K
authors.lastname: Kondo
authors.forename: Matthew
authors.initials: M
authors.lastname: Gipson
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rochon
authors.forename: Rajan
authors.initials: R
authors.lastname: Gupta
authors.forename: Wells
authors.initials: W
authors.lastname: Messersmith
authors.forename: Tom
authors.initials: T
authors.lastname: Purcell
authors.forename: Janette
authors.initials: J
authors.lastname: Durham
mesh_terms: D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: HCC; RECIST; Response Evaluation Criteria In Solid Tumors; hepatocellular carcinoma