Thermal Ablation for Intrahepatic Cholangiocarcinoma in Cirrhosis: Safety and Efficacy in Non-Surgical Patients

Clinical question:
Is thermal ablation effective as first-line treatment for cirrhotic patients with multiple cholangiocarcinoma tumors?

Take-away point:
Thermal ablation can effectively control cholangiocarcinoma in select patients who are not surgical candidates.

Reference:
Díaz-González Á, Vilana R, Bianchi L, et al. Thermal Ablation for Intrahepatic Cholangiocarcinoma in Cirrhosis: Safety and Efficacy in Non-Surgical Patients. J Vasc Interv Radiol. 2020;31(5):710-719.

Click here for abstract

Study design:
Retrospective cohort, single center

Funding source:
None

Setting:
Academic hospital

Summary:

A retrospective review evaluating outcomes in non-surgical cirrhotic patients with biopsy-proven intrahepatic cholangiocarcinoma (ICC) who underwent ablation. Twenty-seven (27) patients were included in the study, with median lesion size being 21 mm (range: 11 – 45 mm). Completely radiologic necrosis was achieved in 25/27 cases (92.6%) and median overall survival (OS) of the entire cohort was 30.6 months; for patients with a single lesion < 2 cm, OS was 94.5 months. Twenty-one (21) patients (77.8%) had tumor recurrence during follow-up. Only 1 severe treatment-related adverse event was encountered due to intestinal perforation possibly related to laparotomy access that was used for this case.

Commentary:

The authors present a review of a specific patient population, and outcomes of two separate ablation modalities (radiofrequency and microwave) for treatment of ICCs in non-surgical cirrhotic patients. Lesion outcomes and OS were comparable to reported surgical outcomes.

Main limitations appropriately addressed by the authors include retrospective design, long period over which patients were treated (and advances in ablation and imaging technology during this period).

This review suggests that similar medial survival and recurrence outcomes to surgical resection of ICCs can be obtained if ablation is pursued, specifically in solitary lesions < 2 cm in size.

Post Author:

David M. Tabriz, MD

Assistant Professor
Rush University Medical Center

@DrDaveTabriz