title: Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  Hepatic artery based therapies (HAT) are offered for patients with unresectable intrahepatic cholangiocarcinoma (ICC). We aimed to evaluate the comparative effectiveness of HAT -hepatic arterial infusion (HAI), transcatheter arterial chemoembolization (TACE), drug-eluting bead TACE (DEB-TACE), and Yttrium(90) radioembolization (Y-90) for unresectable ICC.
  
  
  METHODS
  A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013004830) that utilized PubMed (2003-2013). Primary outcome was median overall survival (OS), and secondary outcomes were tumor response to therapy and toxicity.
  
  
  RESULTS
  A total of 20 articles (of 793, n=657 patients) were selected for data extraction. Highest Median OS was observed for HAI (22.8, 95% CI 9.8-35.8) months versus Y90 (13.9, 9.5-18.3) months versus TACE (12.4, 10.9-13.9) months versus DEB-TACE (12.3, 11-13.5) months. Response to therapy (complete and partial) was highest for HAI (56.9%, 95%CI 41.0-72.8) versus Y90 (27.4%, 17.4-37.5) versus TACE (17.3%, 6.8-27.8). The grade III/IV toxicity (Events per patient) was highest for HAI (0.35, 95% CI 0.22-0.48) versus TACE (0.26, 0.21-0.32) versus DEB-TACE (0.32, 0.17-0.48).
  
  
  CONCLUSIONS
  For patients with unresectable ICC treated with HAT, HAI offered the best outcomes in terms of tumor response and survival but may be limited by toxicity.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Boehm
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.forename: John T
authors.initials: JT
authors.lastname: Miura
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Zacharias
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D016461:Chemoembolization, Therapeutic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000628:therapy*; D004337:Drug Carriers; D004621:Embolization, Therapeutic / Q000379:methods; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D004337:Drug Carriers; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: chemotherapy; cholangiocarcinoma; hepatectomy; liver blood supply; regional perfusion