Precision Hepatic Arterial Irinotecan Therapy in the Treatment of Unresectable Intrahepatic Cholangiocellular Carcinoma: Optimal Tolerance and Prolonged Overall Survival
| Autor: | Gregory J. Dubel, Tiffany Metzger, Kelly M. McMasters, Robert C.G. Martin, Suzanne C. Schiffman, Charles R. Scoggins, Ivan Kralj, Tomáš Andrašina, Cliff Tatum |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Salvage therapy Irinotecan Cholangiocarcinoma Hepatic Artery FOLFOX medicine Humans Prodrugs Prospective Studies Survival rate Aged Aged 80 and over Salvage Therapy Chemotherapy business.industry Middle Aged Antineoplastic Agents Phytogenic Gemcitabine Surgery Survival Rate Regimen Bile Ducts Intrahepatic Treatment Outcome Bile Duct Neoplasms Oncology Camptothecin Female Hepatectomy business Follow-Up Studies medicine.drug |
| Zdroj: | Annals of Surgical Oncology. 18:431-438 |
| ISSN: | 1534-4681 1068-9265 |
| DOI: | 10.1245/s10434-010-1333-4 |
| Popis: | Unresectable intrahepatic cholangiocellular carcinoma (ICC) carries a poor prognosis, and there are few chemotherapeutic treatments to prolong survival. The purpose of this study was to assess the efficacy of drug-eluting bead (DEB) therapy by transarterial infusion for unresectable ICC.A prospective multicenter study of ICC patients who received hepatic arterial DEB therapy.Twenty-four patients with unresectable ICC were treated with DEB. Ten patients (41.6%) had recurrent ICC after prior radiofrequency ablation (n = 3) or hepatectomy (n = 7). Twenty patients (80%) had received prior chemotherapy, mostly of gemcitabine (n = 8) or Eloxatin (n = 6). The percent of overall liver involvement was25% (n = 8), 26% to 50% (n = 11), and50% (n = 4). Ten patients (40%) had sites of extrahepatic disease located at lymph nodes (n = 5), bone (n = 2), peritoneum (n = 1), lung (n = 1), and mouth (n = 1). A total of 42 DEB treatments were administered. Eight were administered in combination with systemic chemotherapy of FOLFOX (n = 4) or Gemzar (n = 4). Twelve patients (48%) received a second treatment, and 4 patients (16%) received a third treatment. The median length of stay was 23 h (23-72 h). Eleven adverse reactions (26.2%) were reported. Of these, 7 (63.6%) were minor (less than grade 3). One patient died from hepatorenal syndrome. The disease of one patient was downstaged to resection. After a median follow-up of 13.6 months, the median overall survival of a multitherapeutic regimen with DEB therapy was significantly greater than chemotherapy alone (17.5 vs. 7.4 months; P = 0.02).Bead therapy is safe and effective in patients with unresectable ICC. There is a marked survival benefit when DEB therapy is used as adjunctive therapy. |
| Databáze: | OpenAIRE |
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