title: Intra-arterial therapy for advanced intrahepatic cholangiocarcinoma: a multi-institutional analysis.
abstract: BACKGROUND
  Many patients with intrahepatic cholangiocarcinoma (ICC) present with advanced and inoperable disease. Data on the safety and efficacy of intra-arterial therapy (IAT) for ICC are limited.
  
  
  METHODS
  Between 1992 and 2012, a total of 198 patients with advanced ICC treated with IAT were retrospectively identified from the databases of five major hepatobiliary institutions. Data on clinicopathological factors, morbidity, response rates, and overall survival were collected and analyzed.
  
  
  RESULTS
  Median patient age was 61 years. Median tumor size was 8.1 cm, and 47.5% patients had a solitary lesion. IAT consisted of conventional transarterial chemoembolization (cTACE) (64.7%), drug-eluting beads (DEB) (5.6%), bland embolization (TAE) (6.6%), or yttrium-90 radioembolization (23.2%). Median number of IAT sessions was 2 (range 1-8). The median time between IAT sessions was 48 days. The periprocedural morbidity was 29.8%; most complications were minor (n = 43); however, 16 patients had a grade 3-4 complication. Assessment of tumor response revealed complete or partial response in 25.5% patients, while 61.5% had stable disease; 13.0% had progressive disease. Median overall survival was 13.2 months and did not differ on the basis of the type of IAT (cTACE, 13.4 months vs. DEB 10.5 months vs. TAE, 14.3 months vs. yttrium-90, 11.3 months; P = 0.46). IAT response on modified response evaluation criteria in solid tumors (mRECIST; hazard ratio for complete-partial response 0.49, 95% confidence interval 0.30-0.81; P < 0.001) was independently associated with better survival.
  
  
  CONCLUSIONS
  IAT for ICC was safe and led to stable disease or partial to complete response in up to three-quarters of patients. Among patients with an IAT response, overall survival was prolonged. The role of IAT therapy for ICC warrants further prospective evaluation in clinical trials.
authors.affiliation: Division of Surgical Oncology, Departments of Surgery, Interventional Radiology and Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Elena N
authors.initials: EN
authors.lastname: Petre
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Kalva
authors.forename: Eleni
authors.initials: E
authors.lastname: Liapi
authors.forename: David
authors.initials: D
authors.lastname: Cosgrove
authors.forename: Donielle
authors.initials: D
authors.lastname: Neal
authors.forename: Ihab
authors.initials: I
authors.lastname: Kamel
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.forename: Jean-Francois H
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate