Baydoun Hussein, Meirovich Harley, Maroun Gilbert, Coburn Natalie, David Elizabeth
Department of Vascular and Interventional Radiology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
Department of General Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
Ann Palliat Med. 2021 Feb;10(2):1784-1791. doi: 10.21037/apm-19-362.
The purpose of this case series is to assess the safety and efficacy, as well as the overall survival (OS) and progression free survival (PFS) of patients with intrahepatic cholangiocarcinoma (ICC) treated with percutaneous ablation, transarterial arterial chemoembolization (TACE) or a combination of both at our institution.
Ten patients with pathological diagnosis of adenocarcinoma treated at out institution between January 1st 2013 and January 1st 2019 were reviewed. Three patients received a combined TACE and ablation treatment, three patients received TACE without ablation and four patients were treated with ablation only. Ablation technical success was determined by absence of residual tumor in the ablation zone on follow-up imaging one-month post-ablation. TACE response was assessed using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Technical success was defined as injection of chemoembolic material in the involved liver lobes. PFS and OS were calculated from the date of diagnosis.
In the TACE and radiofrequency ablation (RFA) group, OS was 12, 55 and 56 months; PFS was 5, 6 and 32 months, one patient died and two others remain alive. In the TACE group, OS was 29, 10 and 5 months; PFS was 15, 10 and 4 months. All three patients remain alive. In the ablation group, OS and PFS were 16, 31, 30 and 40 months. All patients remain alive. Overall, 9 of 10 patients are alive, with a Median OS and PFS of 29.5 and 15.5 months, respectively, with some patients remain alive over four years following initial presentation.
Our study shows that ablation and TACE in combination with more traditional modalities such as chemoradiation and surgical resection can extend survival in patients with ICC significantly. Locoregional therapy is well tolerated with only minor adverse events. The use of stereotactic body radiation therapy (SBRT) with ablation demonstrated the synergistic nature of using multiple lines of interventions.
本病例系列的目的是评估在我们机构接受经皮消融、经动脉化疗栓塞（TACE）或两者联合治疗的肝内胆管癌（ICC）患者的安全性和疗效，以及总生存期（OS）和无进展生存期（PFS）。
回顾了2013年1月1日至2019年1月1日在我们机构接受腺癌病理诊断的10例患者。3例患者接受了TACE与消融联合治疗，3例患者仅接受了TACE治疗，4例患者仅接受了消融治疗。消融技术成功的判定标准为消融后1个月的随访影像显示消融区内无残留肿瘤。使用实体瘤改良反应评估标准（mRECIST）评估TACE反应。技术成功定义为在受累肝叶注入化疗栓塞材料。PFS和OS从诊断日期开始计算。
在TACE与射频消融（RFA）组中，OS分别为12、55和56个月；PFS分别为5、6和32个月，1例患者死亡，另外2例患者仍存活。在TACE组中，OS分别为29、10和5个月；PFS分别为15、10和4个月。所有3例患者均存活。在消融组中，OS和PFS分别为16、31、30和40个月。所有患者均存活。总体而言，10例患者中有9例存活，中位OS和PFS分别为29.5个月和15.5个月，部分患者在初次就诊后存活超过4年。
我们的研究表明，消融和TACE与放化疗和手术切除等更传统的治疗方式联合使用，可显著延长ICC患者的生存期。局部区域治疗耐受性良好，仅出现轻微不良事件。立体定向体部放射治疗（SBRT）与消融联合使用显示了多种干预措施的协同作用。
