Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Expert Rev Gastroenterol Hepatol. 2024 Sep;18(9):505-519. doi: 10.1080/17474124.2024.2402358. Epub 2024 Sep 17.
Intrahepatic cholangiocarcinoma (ICC) is the 2nd most common primary liver malignancy. For nonsurgical candidates, the primary treatment option is systemic chemotherapy, which can be combined with locoregional therapies to enhance local control. Common intra-arterial locoregional therapies include transarterial hepatic embolization, conventional transarterial chemoembolization, drug-eluting bead transarterial chemoembolization, transarterial radioembolization with Yttrium-90 microspheres, and hepatic artery infusion. This article aims to review the latest literature on intra-arterial locoregional therapies for treating ICC.
A literature search was conducted on PubMed using keywords: intrahepatic cholangiocarcinoma, intra-arterial locoregional therapy, embolization, chemoembolization, radioembolization, hepatic artery infusion, and immunotherapy. Articles from 2008 to 2024 were reviewed. Survival data from retrospective and prospective studies, meta-analyses, and clinical trials were evaluated.
Although no level I evidence supports the superiority of any specific intra-arterial therapy, there has been a shift toward favoring radioembolization. In our expert opinion, radioembolization may offer superior outcomes when performed by skilled operators with meticulous planning and personalized dosimetry, particularly for radiation segmentectomy or treating lobar/bilobar disease in appropriate candidates.
肝内胆管细胞癌（ICC）是第 2 常见的原发性肝脏恶性肿瘤。对于不能手术的患者，主要治疗选择是全身化疗，联合局部区域治疗可增强局部控制。常见的动脉内局部区域治疗包括经动脉肝栓塞术、传统经动脉化疗栓塞术、载药微球经动脉化疗栓塞术、钇-90 微球经动脉放射栓塞术和肝动脉灌注。本文旨在综述 ICC 动脉内局部区域治疗的最新文献。
在 PubMed 上使用关键词进行文献检索：肝内胆管癌、动脉内局部区域治疗、栓塞、化疗栓塞、放射栓塞、肝动脉灌注和免疫治疗。综述了 2008 年至 2024 年的文章。评估了回顾性和前瞻性研究、荟萃分析和临床试验的生存数据。
虽然没有一级证据支持任何特定的动脉内治疗具有优越性，但人们越来越倾向于选择放射栓塞。根据我们的专家意见，对于有经验的操作者来说，放射栓塞在精心规划和个性化剂量学的情况下，可能会提供更好的结果，特别是对于放射性肝段切除术或治疗合适患者的叶/多叶疾病。
