Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma - Clinical efficacy and factors influencing outcomes

BACKGROUND. The role of transcatheter arterial chemoembolization (TACE) or transcatheter arterial chemoinfusion (TACI) for unresectable intrahepatic cholangiocarcinoma (ICC) has recently been questioned. The aim of the study was to evaluate the clinical efficacy of TACE or TACI in patients with unresectable ICC and to identify prognostic factors associated with clinical success. METHODS. From 1997 to 2007, 49 patients with unresectable ICC were treated with TACE (n = 124) or transcatheter arterial chemoinfusion (TACI) (n = 96). tumor response was evaluated based on computed tomography, scans obtained 1 month to 3 months after TACE or TACI Factors associated with clinical success were evaluated using multivariate logistic regression analysis. Factors associated with the survival period were evaluated using multivariate Cox regression analysis. RESULTS. After treatment, 27 (55%) of the patients showed radiographic response. Multivariate analysis confirmed that tumor vascularity (odds ratio [OR], 31.2; p =.002) was the only independent factor associated with radiographic response. The median and mean survival periods in our study patients were 12 and 24 months. Multivariate Cox regression analyses showed that tumor size (OR, 2.64; P =.048), tumor vascularity (OR, 13.5; P <.001), and the Child-Pugh class (OR, 3.65: P =.014) were the independent factors associated with the length of the survival period. CONCLUSIONS. Hepatic intra-arterial chemotherapy is well tolerated and may be effective to prolong survival of patients with unresectable ICC. Tumor vascularity is significantly associated with radiographic response. Large tumor size, tumor hypovascularity, and Child-Pugh class B were poor prognostic factors for determining the patient survival period.